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Item type Dissertation
Format Text-based Document
Title Towards an Informatics Competent Nursing Profession:Validation of the Self-assessment of Nursing InformaticsCompetency Scale (SANICS) Before and After OnlineInformatics Training
Authors Godsey, Judi Allyn
Downloaded 8-May-2018 15:23:08
Link to item http://hdl.handle.net/10755/621361
TOWARDS AN INFORMATICS COMPETENT NURSING PROFESSION:
VALIDATION OF THE
SELF-ASSESSMENT OF NURSING INFORMATICS COMPETENCY SCALE (SANICS)
BEFORE AND AFTER ONLINE INFORMATICS TRAINING
A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE
UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
IN
NURSING
May 2015
By
Judi A. Godsey
Dissertation Committee:
Debra Mark, Chairperson
Estelle Codier
Lorrie Wong
Sunmoo Yoon
Curtis Ho
Keywords: Informatics, competency, SANICS, psychometrics, training
i
Copyright
2015
Judi Allyn Godsey
ii
Acknowledgements
I wish to express sincere appreciation to my advisor and chair, Dr. Debra Mark, who has
been a model mentor and a highly competent guide on my journey to a PhD. Many thanks to the
members of my dissertation committee, Drs. Codier, Ho, and Wong, and a special thanks to Dr.
Yoon, who created and graciously shared the SANICS instrument as the topic for my
dissertation, along with much expertise and guidance on psychometrics. A special thanks to my
friend and statistical coach, Greg Grady, who patiently guided and instructed me on all things
psychometric.
This dissertation is dedicated to my loving and supportive parents, Bob and Erna Godsey,
who always believed in and nurtured my potential. To my sisters, Debbie, Pam and Tonja, who
are my cheerleaders, and lifelong best friends. To my extended family members, including my
forever friends Debbie and Phyllis, who have remained steadfastly positioned as a source of
support, prior to and during the years leading up to this degree. My deepest appreciation to Dr.
Debra Breneman, who long ago coaxed, urged, and ultimately persuaded a relatively new
Associate Degree RN to leap outside of her comfort zone and relentlessly seek higher ways of
knowing. And to my wonderful children, Amy and Allen (and my brand new granddaughter,
Allyn), who inspire me to be more than I am. And finally, I extend my warmest gratitude to my
dedicated husband and life partner, Buddy, who consistently sees exciting opportunities instead
of insurmountable barriers.
I would not be here without the people acknowledged on this page, and I am deeply and
infinitely grateful for your influence and presence in my life.
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Abstract
Nurses should be involved in healthcare initiatives that incorporate informatics as an
essential tool for improving health outcomes (IOM, 2010). However, nurses frequently report
lack of competency to perform the most basic computer functions, outside of those required
within their work environment (Hwang, 2011). Without educational or training interventions,
nurses are limited in their ability to effectively use information technology in practice (Greiner,
2003). This study explored the psychometric performance of the Self-Assessment of Nursing
Informatics Competencies Scale (SANICS) when used to measure informatics competency in a
population of entry-level nursing students. Data collected before and after an online informatics
training intervention (SOLO-IT) confirmed the factor structure and internal consistency
reliability of the SANICS. Statistically significant increases (p < 0.001) were reported by
participants (n = 496) on 27 of 30 items measuring self-perceptions of informatics competencies.
Significant differences (p < 0.001) in each sub-scale mean score before and after completion of
SOLO-IT confirmed the construct validity of the SANICS. Results of this study support the
SANICS as a psychometrically sound instrument for measuring perceived informatics
competencies in entry level nursing students. Diffusion of informatics competency throughout
the nursing workforce could depend upon the availability of on-demand training resources and
valid instruments which support nurses as competent users of informatics in an era of ubiquitous
health information technology. Findings from this study provide preliminary evidence that
SOLO-IT may be an effective tool for improving perceptions of informatics competencies
among entry level nursing students. Future studies are recommended using paired samples of
nurses and nursing students from diverse populations, as well as studies which correlate
perceived competencies with actual demonstrated skills.
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Table of Contents
Chapter I: Introduction ................................................................................................................1
Background ......................................................................................................................................2
American Association of Colleges of Nursing ...........................................................................2
Technology and informatics Guiding Educational Reform ........................................................4
The National League of Nursing.................................................................................................6
Nursing Informatics and the Affordable and Accountable Care Act ..........................................6
Institute of Medicine ...................................................................................................................7
Significance......................................................................................................................................8
Purpose ...........................................................................................................................................10
Research Questions ........................................................................................................................11
Methods..........................................................................................................................................12
Summary ........................................................................................................................................12
Chapter II: Review of the Literature ........................................................................................14
Theoretical Framework ..................................................................................................................14
Theoretical Model- Principal Components of Scale: Developing Psychometrically Sound
Instruments .....................................................................................................................................14
Psychometrics ................................................................................................................................16
Principal Component Analysis .................................................................................................16
Internal Consistency Reliability ................................................................................................17
Construct Validity .....................................................................................................................17
Responsiveness .........................................................................................................................18
Studies Describing Informatics Competencies .............................................................................19
Instruments to Measure Informatics Competencies ......................................................................22
Graduating Nurses’ Self-Evaluation of IT Competencies .......................................................23
Computer Literacy Scale for Newly Enrolled College Students ..............................................24
Assessment Tool for Nursing Student Computer Competencies ..............................................24
The eNNI Project ......................................................................................................................25
Computer Competencies in the Curriculum .............................................................................25
Survey of Beginning Nurse Competencies ...............................................................................26
Computer Competencies Survey and Assessment Tool ...........................................................26
Gassert/McDowell Computer Literacy Survey .........................................................................27
TIGER Initiative Informatics Competencies ............................................................................27
Informatics Competency Questionnaire ...................................................................................28
Technology Skills Assessment Survey .....................................................................................29
Competency Assessment Tool ..................................................................................................29
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The Self-Assessment of Nursing Informatics Competency Scale ............................................29
Choi ......................................................................................................................................31
Choi and De Martinas ..........................................................................................................31
Choi and Bakken ..................................................................................................................32
Informatics Training and Assessment ............................................................................................42
European Computer Driver’s License (ECDL) Certification ...................................................43
TIGER Virtual Demonstration Center .....................................................................................44
Nursing Resources: A Self-Paced Tutorial ...............................................................................45
IC3 Training and Certification Program ...................................................................................46
The Passport Project for Nursing Success ................................................................................46
Computer Competency Tutorial ...............................................................................................48
Information Literacy Tutorial ...................................................................................................48
Pre-test for Attitudes Toward Computers in Healthcare ...........................................................49
Summary .......................................................................................................................................53
Chapter III: Research Methodology .........................................................................................55
Introduction ....................................................................................................................................55
Research Questions ..................................................................................................................55
Research Design ............................................................................................................................56
Conceptual Definitions ..................................................................................................................56
Informatics ................................................................................................................................56
Informatics Competency ...........................................................................................................57
Informatics Knowledge ........................................................................................................57
Computer Skills ...................................................................................................................58
Operational Definitions ..................................................................................................................61
Entry Level Nursing Student ...................................................................................................61
Blackboard ................................................................................................................................61
Informatics Curricular Instruction ...........................................................................................61
Informatics Training ................................................................................................................61
Competency on the SANICS ....................................................................................................62
Instrumentation ..............................................................................................................................62
Method to Test the SANICS Instrument ...................................................................................64
Sample..................................................................................................................................65
SANICS and SOLO-IT ..................................................................................................................65
Instructional Design of SOLO-IT .............................................................................................66
Self-Directed Learning ........................................................................................................66
SOLO’s Web Based Modules ...................................................................................................67
Plan for Data Collection and Analysis ..........................................................................................73
Process to Determine Feasibility ..............................................................................................73
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Data Analysis Plan ...................................................................................................................74
Statistical Power ..................................................................................................................75
Plan for Statistical Analysis .................................................................................................76
Ethical Considerations ............................................................................................................ 76
University of Hawaii IRB Approval ....................................................................................76
Xavier University IRB Approval .........................................................................................78
Limitations of the Design..........................................................................................................79
Summary ........................................................................................................................................80
Chapter IV: Results ....................................................................................................................81
Research Design………………………………………………………………………………….81
Setting and Sample ...................................................................................................................81
Profile of Respondents ..............................................................................................................83
Presentation of Data for Research Question One ..........................................................................84
Principal Component Analysis .................................................................................................84
Parallel Analysis .......................................................................................................................86
Psychometric Analysis: Comparisons with Original SANICS Study.......................................86
Presentation of Data for Research Question Two ..........................................................................89
Value of SOLO-IT .........................................................................................................................91
Summary ........................................................................................................................................93
Chapter V: Discussion ................................................................................................................94
Discussion ......................................................................................................................................94
Sample Size and Return Rates ..................................................................................................94
Study Participants .....................................................................................................................94
Research Question One ..................................................................................................................94
Research Question Two .................................................................................................................95
Value of SOLO-IT .........................................................................................................................96
Limitations .....................................................................................................................................97
Implications for Future Research ...................................................................................................99
Summary ......................................................................................................................................100
References ...................................................................................................................................114
List of Tables
Table 1: Informatics Competency Instruments ...........................................................................33
Table 2: Non-Curricular Informatics Training Resources ..........................................................50
Table 3: BSN Demographics ......................................................................................................83
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Table 4: Factor Structure Matrix Pre-and Post-SOLO-IT ..........................................................85
Table 5: Factor Structure Compared to Original SANICS Study ...............................................87
Table 6: Average Scores for Each SANICS Sub-Scale Pre/Post SOLO-IT ...............................90
Table 7: SANICS Scores Post SOLO-IT Compared to Original SANICS Study ......................91
Table 8: Value of SOLO-IT ........................................................................................................92
List of Figures:
Figure 1: Theoretical Model: Principal Components of Scale for Developing Psychometrically
Sound Instruments ........................................................................................................................18
Figure 2: SOLO-IT and SANICS: Participation and Return Rates ..............................................82
Figure 3: Parallel Analysis ............................................................................................................86
List of Appendices
Appendix A: SANICS Instrument ..............................................................................................102
Appendix B: SOLO-IT Course Overview and Grading Criteria ................................................104
Appendix C: Power Analysis Using the G Power Program .......................................................111
Appendix D: University of Hawaii IRB Approval ....................................................................112
Appendix E: Xavier University IRB Approval ...........................................................................113
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Chapter I
Introduction
Numbering more than three million, licensed Registered Nurses (RNs) make up the
largest group of healthcare professionals in the United States (Health Resources Services
Administration, 2010). Advances in healthcare have created a nursing workforce increasingly
dependent upon technology to deliver innovative therapies at the bedside, and to interpret
massive amounts of quality-related outcomes data in the executive boardroom. The information
age is producing data at rates that exceed the ability to use it. The Economist estimates medical
centers are home to almost one billion terabytes of data, “equivalent to almost two trillion file
cabinets worth of information” (2010, pg. 3).
Nursing informatics is “a specialty that integrates nursing science, computer science,
and information science to manage and communicate data, information, and knowledge in
nursing practice” (American Nurses Association [ANA], 2001, p.17). Nurses capable of
integrating informatics solutions into an automated healthcare environment will be essential to
the future of nursing and the promotion of health that spans “time and place” and “wellness and
health maintenance activities” (Health Information and Management System Society [HIMSS],
2012, p. 3). For more than a decade, nursing researchers have recognized that evidence based
practice (EBP) would be dependent upon nursing’s ability to demonstrate expert knowledge in
patients’ individual and collective decision making processes (McCormack, Kitson, Harvey,
Rycraft-Malone, Titchen & Seers, 2002). Such expert knowledge in practice is based on a
foundational ability to use information technology effectively and manage electronic sources of
information, which assumes at least a basic education in informatics (Courey, Benson-Soros,
Deemer, & Zeller, 2006; IOM, 2003).
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Background
As the largest group of clinical health information technology users, nurses must
possess a minimum set of technical competencies needed for the electronic medical record
(EMR), including basic computer skills and information literacy (Ball, Douglas & Hinton-
Walker, 2011). Basic computer literacy (competency) is defined as “the use of personal
computers, including the use of software tools such as word processing, spreadsheets, databases,
presentation graphics, and e-mail” (Hebda & Czar 2013, p. 8). Information literacy is the ability
to access, process, and use information and is an essential component of nursing informatics
competency (IOM, 2011). The IOM has identified information literacy as the recommended
standard for nursing and nursing students (2011).
Significant contributions concerning the role of nursing informatics have been made
during the past decade. Staggers and colleagues defined and described informatics
competencies, skills, knowledge, and abilities based on educational preparation and expertise:
beginning nurse, experienced nurse, informatics nurse specialist, and informatics innovator
(Staggers, Gassert, & Curran, 2001, 2002). Their seminal research has informed the
development of informatics competency measurements for the nursing profession and has
influenced many of the standards commonly used by leading professional nursing organizations.
These organizations include the American Association of Colleges of Nursing (AACN, 2008),
the TIGER Initiative (2010) and the National League of Nursing (2008).
American Association of Colleges of Nursing (AACN)
The AACN’s “Essentials of a Baccalaureate Education for Professional Practice,”
provides guidelines for nursing practice (2008). In 2008, the AACN included the mandate that
informatics be included as an “essential element” of a baccalaureate nursing degree, since
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“computer and information literacy are crucial to the future of nursing” and provide a bridge
between the “preparation-practice” gap (p. 17).
The 2008 guidelines include “Information Management and Application of Patient
Care Technology” as one of the nine “Essentials” for a professional nursing education (p. 17).
Standards outlined under the technology “Essential” include:
1. Demonstrate skills in using patient care technologies, information systems, and
communication devices that support safe nursing practice.
2. Use telecommunication technologies to assist in effective communication in a variety of
healthcare settings.
3. Apply safeguards and decision making support tools embedded in patient care
technologies and information systems to support a safe practice environment for both
patients and healthcare workers.
4. Understand the use of computerized information systems to document interventions
related to achieving nurse sensitive outcomes.
5. Use standardized terminology in a care environment that reflects nursing’s unique
contribution to patient outcomes.
6. Evaluate data from all relevant sources, including technology, to inform the delivery of
care.
7. Recognize the role of information technology in improving patient care outcomes and
creating a safe care environment.
8. Uphold ethical standards related to data security, regulatory requirements, confidentiality,
and clients’ right to privacy.
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9. Apply patientcare technologies as appropriate to address the needs of a diverse patient
population.
10. Advocate for the use of new patient care technologies for safe, quality care.
11. Recognize that redesign ofworkflow and care processes should precede implementation
of care technology to facilitate nursing practice.
12. Participate in evaluation of information systems in practice settings through policy and pr
ocedure development (p. 17).
The implementation of informatics as an essential component of accreditation
standards is an important step in the process of transforming nursing education in a manner that
prepares graduates to practice competently. Such skills are critical in a technology driven
healthcare environment (Ball, Douglas & Hinton-Walker, 2011).
Technology and informatics Guiding Educational Reform (TIGER)
Technology and Informatics Guiding Educational Reform (the TIGER Initiative) is an
independent, grassroots nursing initiative whose primary focus is educational reform in nursing
informatics (Ball, et. al, 2011). The TIGER Initiative began in 2006 in response to the growing
need for an informatics competent nursing workforce. The TIGER Initiative catalyzed the
formation of the Alliance for Nursing Informatics (ANI), a coalition of 20 nursing informatics
professional societies, and major nursing organizations such as the ANA, Association of Nurse
Executives (AONE), the American Association of Colleges of Nursing (AACN) (TIGER, 2008).
The ANI also includes an additional 170 diverse organizations which seek to make informatics
“nursing’s stethoscope by the 21st century” (Ball, et al, 2011, p. 19; TIGER, 2008, 2010). The
TIGER Initiative focuses on “the need to engage nurses in all settings in the national effort to
5
prepare the healthcare workforce toward effective adoption of electronic health records” (p. 10).
The following recommendations emerged from the TIGER Summit (2010):
Institute a national marketing campaign to promote the value of technology in a multi-
disciplinary way that supports an accepting culture.
Include Health Information Technology (HIT) in every strategic plan, mission, and
vision statement; use of HIT is embraced by executives, deans, all point of care
clinicians and students with goal of high quality care and safety.
Establish multidisciplinary teams that embrace a shared vision and operate cohesively to
push for broad technology integration within/across entire organizations.
Develop mutual respect between/among clinicians who may bring different skills and
knowledge (p.14).
The TIGER Initiative developed a TIGER Informatics Competencies Collaborative
(TICC). This group of informatics and nursing experts was charged with the establishment of a
minimum set of informatics competencies (Ball, et al, 2011). The TICC also outlined
basic computer and information literacy skills for nurses and nursing students. Recommended
information literacy and computer skills are described below (Gugerty & Delaney, 2009):
Information literacy skills identified by TIGER.
1. Determine the nature and extent of the information needed
2. Access needed information effectively and efficiently
3. Evaluate information and its sources critically and incorporates selected information
into his or her knowledge base and value system
4. Individually or as a member of a group, use information effectively to accomplish a
specific purpose
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5. Evaluate outcomes of the use of information (p.5).
Computer skills identified by TIGER.
1. Concepts of Information and Communication Technology (ICT)
2. Using the Computer and Managing Files
3. Word Processing
4. Spreadsheets
5. Using Databases
6. Presentation
7. Web Browsing and Communication (p. 3).
The National League of Nursing
The National League of Nursing (NLN) has called for the development of innovative
educational programs which improve informatics competencies and enable competent use of
information technologies (2008). For more than a decade, the nursing literature has reported that
nursing schools lack standardization as to the type and complexity of computer skills required for
nursing students (Sinclair & Gardner, 1999) The ability for nursing education to integrate
computer competency and information literacy “will require nursing curriculum reform and an
infusion of technologies for learning” (p. 40).
Nursing Informatics and the Affordable and Accountable Care Act
Nurses should be involved in healthcare initiatives that incorporate informatics as an
essential tool for improving health outcomes (IOM, 2010). As a result of the Affordable Care
Act (ACA) of 2010, healthcare delivery is transitioning to electronic health records for
meaningful use and exchange of information (Department of Health and Human Resources
[HHS], 2010). The ACA includes broad application of informatics competencies to support the
7
meaningful use of information supporting quality patient outcomes. However, a chasm between
knowledge and practice prevails due to incomplete adoption of healthcare innovations (IOM,
2001; Glanz, Rimer &Viswanath, 2008). Nurses deficient in basic informatics competencies
have limited ability to use and apply communication and information technology in their practice
(IOM, 2003, p. 85). Nurses are the largest group of clinical users of health information
technologies and must master a minimum set of competencies needed for the electronic medical
record (EMR), including basic computer skills and information literacy (Ball, et al, 2011).
Employing agencies may understandably assume that requisite computer skills are being taught
during a student’s undergraduate college education. However, nurses frequently lack the
minimum level of competency to work efficiently or effectively with computerized information
systems (Thede & Sewell, 2004; Wilbright, et. al, 2006). Inexperience with technology is one of
the most common factors impeding the adoption of Electronic Medical Records (EMR) (Mcginn,
et al. 2012). Effective use of electronic health systems depend on competence with the complete
system, including advanced tools for charting and data management (Saba & McCormick, 2011).
Institute of Medicine (IOM)
Ongoing advances in health informatics require the preparation of a nursing
workforce competent in computer based applications. In a groundbreaking report, The Future of
Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) called for nurses
to be involved in healthcare initiatives that incorporate informatics as an essential tool for
improving health outcomes (2010). The Institute of Medicine defines information literacy as the
ability to access, process, and use information (2011). A key component of informatics
competency is information literacy, which is the ability to find, retrieve, and analyze information
8
(American Library Association, 2012). Information literacy is considered an essential
competency and is the recommended standard for all nurses and nursing students (IOM, 2011).
Significance
Informatics competency is readily accepted as basic technology skills that nurses must
have to perform their duties (McNeil, Elfrink, Pierce, Beyea, Bickford, & Averill 2005; Staggers,
Gassert & Curran, 2001; Yoon, Yen, & Bakken, 2009). Effective and efficient use of electronic
health systems rely on competence with the complete system, including the ability to use
advanced tools designed for charting and data management (Saba & McCormick, 1996). Expert
testimony provided to the Office of the National Coordinator (ONC) revealed significant
challenges for nurses when locating pertinent data “in the sea of available electronic information
in the EMR” (Staggers, 2011, p. 542). Inexperience with technology has been identified as one
of the most common factors impeding the adoption of the EMR (Mcginn, et al. 2012).
For the past 30 years, nurses have been encouraged to acquire and build upon
informatics competencies to perform their role optimally (Ball & Hannah,1984; Graves &
Chocoran, 1989; Herbert, 1999; Saba & McCormick, 1996; Scholes & Barber, 1980; Staggers,
Thompson, Happ & Bartz, 1998; Turley, 1996). Still, nurses consistently self-report a lack of
competency to perform even the most basic computer functions, outside of those required within
their work environment (Ball, Douglas, Hinton-Walker, 2011; Hwang & Park, 2011; Thede &
Sewell, 2009).
A gap exists in the literature regarding informatics competency training resources for
nurses and the availability of valid, reliable tools to measure their effectiveness. These findings
are surprising given persistent recommendations from professional nursing organizations calling
for a deliberate, systematic approach to improving the basic computer skills and information
9
literacy of the nursing profession (ANA, 2001; IOM, 2011; TIGER, 2008). Despite this call, the
integration of informatics into the nursing curriculum and development of informatics
competencies among nurses is still lacking (Hunter, McGonigle, Dee, Hebda, 2013; Virgona,
2013).
The TIGER Initiative focuses on “helping the nursing profession to adopt informatics
tools, principles, theories, and practices that make healthcare safer and more effective, efficient,
patient-centered, and equitable for all stakeholders” (p. 3). The TIGER Initiative’s Executive
Summary (2010) identified the concern of “informatics illiteracy in nursing education” and
included the imperative for nurses to become competent in the use of technology tools to support
decision making in clinical practice (p. 2). In a recent study (2013), students enrolled in the first
semester of a Doctor of Nursing Practice (DNP) Program were not competent in any of three
categories of computer skills, informatics knowledge, and informatics skills. Despite ubiquitous
use of technology in daily life, the incorporation of basic computer skills and informatics into
nursing curricula is still considered an “essential” need (Virgona, 2013, p. 61). A common
misperception is that younger students enter traditional BSN programs with requisite computer
and information literacy skills. However, recent research suggests that RN to BSN and
Accelerated BSN students may be more competent in informatics than younger Pre-Licensure
students (Choi, 2012). Even though use of technology has been expanded in K-12 education,
“findings indicate that (nursing) students’ computer competencies may be lower than
anticipated” (Elder & Koehn, 2009).
Broad adoption of essential nursing informatics competencies would be advantageous
for the nursing profession (Ball, et al., 2011). The TIGER Initiative calls for competency based
training resources which can help prepare the nursing workforce to improve healthcare delivery
10
using informatics (Ball, et al, 2011). However, informatics competency training resources for
nurses remain insufficient and frequently do not provide validity and reliability data for the
instrument, or lack formalized assessments altogether (2011).
Evidence exists that “without a basic education in informatics, nurses and other
healthcare professionals are limited in their ability to make effective use of communication and
information technology in their practice” (IOM, 2003, p. 85). Educational interventions aimed
directly at informatics competencies of nursing students have proven effective (Choi, 2012;
Flood, Gasiewicz & Delpier, 2010; Tarrant, Dodgson, & Law, 2008, Yoon, et al., 2009).
However, nursing education programs have been slow to support the development of informatics
competencies or to provide the training and resources necessary for nurses to enter the
professional world with adequate technology or information literacy skills (Westra & Delaney,
2008).
Purpose
The TIGER Collaborative issued a Call to Action identifying the need for educational
interventions which foster information technology innovation and adoption by nurses (2008). In
2011, the TIGER Initiative called for competency based training resources which improve basic
informatics competencies (computer skill and information literacy) and prepare the nursing
workforce to improve healthcare delivery using informatics (Ball, et al). While numerous
instruments have been utilized to measure the informatics competencies of nurses, relatively few
research reports provide psychometric data to support the reliability and validity of the
instruments (Lin, 2011). Issues related to computer competency and information literacy have
long been described by researchers, yet few training resources exist and “little attention has been
paid to the validity of scales used” (Lin, 2011, p. 306).
11
This purpose of this study is to evaluate the psychometric performance of the Self-
Assessment of Nursing Informatics Competency Scale (SANICS) before and after completion of
informatics training. Principal component analysis will be used to examine the factor structure
of the SANICS. Internal consistency reliability will be used to examine the psychometric
properties of the SANICS among a sample of BSN entry-level nursing students. Responsive of
the SANICS over time will be examined following completion of Successful Online Learning
and Orientation Informatics Training (SOLO-IT) modules. Construct validity of the SANICS
will be assessed using a known group approach to compare differences in means for each
SANICS subscale (construct) before and after completion of Successful Online Learning and
Orientation Informatics Training (SOLO-IT) modules.
Research Questions
The literature supports an ongoing lack of informatics competencies among the nursing
profession, as well as a lack of valid tools in which to measure them. Additionally, the literature
acknowledges a lack of empirically sound informatics training resources. Research questions to
be answered by this study are as follows:
1) What are the psychometric properties of the SANICS among a population of BSN
entry-level students?
2) Is the SANICS responsive over time when used to measure informatics competencies
following completion of Successful Online Learning and Orientation (SOLO)
Informatics Training (IT) modules?
Hypothesis: There will be a significant difference in SANICS scores between
pre-SOLO and post-SOLO.
12
Methods
Essential informatics concepts will provide the foundational underpinnings for this
research. Authoritative definitions derived from research studies, professional nursing
organizations and national health collaboratives were used to inform the study’s design. A
thorough review of current and historical literature supported the lack of requisite computer
competency and information literacy skills essential for an informatics competent nursing
workforce. The literature also described a persistent lack of reliable and valid tools to measure
those competencies.
National professional nursing organizations recommend web based informatics training
for nurses, as well as rigorous assessment tools and strategies to validate their effectiveness
(Ball, et al., 2011). However, a comprehensive literature search identified a lack of web based
training resources and accompanying instruments used to measure the outcomes of informatics
training. Due to the small number of empirical studies available, the search for training
resources was expanded to include both nursing and educational tools which measure
competencies before and/or after informatics training. Review of curriculum based informatics
instruction and/or health record simulation training sites was excluded from this search.
Summary
Researchers have developed measurement scales which define and quantify the
informatics competency (IC) levels needed for nurses and nursing students (Staggers, Gassert, &
Curran, 2002; Yoon, et al., 2009). Competency levels outlined by these instruments are
comprehensive and span from the “beginning nurse” to “informatics innovator” (Staggers, et al.,
2002). While nursing informatics competencies have been described for more than a decade, a
comprehensive review of the literature revealed a surprising lack of research studies describing
13
training interventions to address the problem of insufficient informatics competencies among
nursing professionals. Additionally, published literature describing valid, reliable assessment
tools to measure the effect of informatics competency training among nurses or nursing students
was relatively sparse.
14
Chapter II
Review of the Literature
Theoretical Framework
This quantitative study will use a post-positivist theoretical perspective grounded in
objectivist epistemology. In post-positivism, objectivity is the “regulatory ideal” but may not be
achievable due to the research process which allows claims to be refined or abandoned altogether
(Guba & Lincoln, 1994, p. 205). The post-positivist approach does not seek to prove a
hypothesis (as with positivism), but rather to indicate a failure to reject the hypothesis (Phillips &
Burbules, 2000). Human knowledge can be challenged and assumptions withdrawn, when
warranted, for further investigation (2000). Quantitative research is defined as “a means for
testing objective theories by examining the relationship among variables” (Creswell, 2009, p. 4).
Quantitative inquiry allows theories to be tested deductively, “building in protections against
bias, controlling for alternative explanations, and being able to generalize and replicate findings”
(Creswell, 2009, p. 4).
Theoretical Model: Principal Components of Scale Theory
Scientific inquiry is dependent upon the adequacy of its measures (Foster and Cone,
1995). Figure 1 illustrates the importance of using psychometrically sound instruments to
accurately measure the informatics competencies necessary for nursing practice in a technology-
driven healthcare environment. This model is built upon the Principal Components of Scale
Theory (Guttman, 1941), which involves a vector of numerical weights or scores with
corresponding principal components. In this system “each numerical score…is proportional to
the sum of the weights for the item response” in such a manner that maximizes the “correlation
ratio” (p. 327). The resulting scoring weights support item reliability by factoring a matrix of
15
inter-item correlations. Principal components are considered correlated with the scores when the
weighted items maximize the coefficient alpha (Lord, 1958).
Validated measurement tools support the development of on-demand training resources
for self-directed learners who work in fast paced healthcare environments. The need for an
informatics competent workforce is mandated by professional nursing standards (AACN), scope
of nursing practice (ANA), and recommendations of authoritative bodies (IOM, NLN). The
model shows the relationship between easily accessed tools for self-directed learning and the
achievement of information technology skills consistent with a technologically competent
nursing workforce prepared for evidence based practice.
Figure 1: Theoretical Model
Principal Components of Scale Theory: Developing Instruments to Support Informatics Training
and Evidence Based Practice
16
Psychometrics
This study will measure the items contained within the Self-Assessment of Nursing
Informatics Competencies Scale (SANICS) and will analyze their psychometric properties.
Psychometric evaluation is concerned with an instrument’s reliability and validity (Carmines &
Zeller, 1979). An instrument is a device used by researchers to measure variables (Neale &
Liebert, 1986). Commonly, research instruments include questionnaires, rating scales, and
physiological or observational measurements (1986). Reliability is established when a measure,
repeated on a different population, remains consistent (Cortina, 1993). The degree to which
evidence supports the interpretation of a test is referred to as validity (Guilford, 1946).
This study will evaluate the psychometric properties of the SANICS instrument using: 1)
principal component analysis, 2) internal consistency reliability, and 3) responsiveness.
Principal Component Analysis
Principal component analysis with oblique (promax) rotation will be used to determine
the factor structure of the SANICS instrument. Principal component analysis is the preferred
method for factor extraction since, unlike factor analysis, it allows for all sources of variability
(unique, shared, or error) to be analyzed (Mertler & Vannatta, 2010). The goal in principal
component analysis is to “extract the maximum variance from the data set, resulting in a few
orthogonal (uncorrelated) components” (2010, p. 234). Parallel analysis will be used to
determine which factors should be retained. In parallel analysis, “eigenvalues from research
data prior to rotation are compared with those from a random matrix of identical dimensionality
to the research data set. Component PCA eigenvalues which are greater than their respective
component parallel analysis eigenvalues from the random data would be retained” (Franklin,
Gibson, Robertson, Pohlmann & Fralish, 1995, p. 100). An eigenvalue is “the amount of total
17
variance explained by each factor, with the total amount of variability in the analysis equal to the
number of original variables in the analysis (i.e. each variable contributes one unit of variability
to the total amount)” (Mertler & Vannatta, 2010, p. 234). Parallel analysis is “considered more
replicable than using eigenvalues or Scree plot to determine the cut-off for retention” (Yoon, et
al, 2009, pg. 548). Factor loadings and promax rotation with Kaiser normalization will be used
to examine and confirm correlations among factors (Tabachnick & Fidell, 2007). Factorial
validity involves the measurement of reference factors to determine if a test theoretically
measures what it was intended to measure (Guilford, 1946). Rotation is “a process by which a
factor solution is made more interpretable without altering the underlying mathematical
structure” (Mertler & Vannatta, 2010, p. 238). Promax rotation is an oblique rotation of factors
to determine their relationship with one another (2010).
Internal Consistency Reliability
Internal consistency reliability of the SANICS instrument will be determined using
Cronbach’s alpha to assess the total scale and each subscale. Cronbach’s alpha (Cronbach, 1951)
is one of the most popular reliability statistics and is used to determine “the internal consistency
or average correlation of items in a survey instrument to gauge its reliability” (Reynaldo &
Santos, 1999, p.2). An acceptable reliability coefficient of 0.7 has been identified as reliable,
though lower thresholds have been used (Nunnally & Bernstein, 1994). A scale which fails to
show variables with high correlation would be considered to have poor reliability (1994).
Construct Validity
Construct validity refers to an instrument’s ability to measure constructs adequately
(Shuttleworth, 2014). Construct validity is frequently measured using intervention studies, where
groups with low scores on the construct being measured are taught the construct, then re-
18
measured. The presence of statistically significant differences between pre and post-test scores
establishes good construct validity (Shuttleworth, 2014).
Construct validity of the SANICS will be assessed using a known group approach to
compare differences in means (averages) for each SANICS subscale (construct) before and after
completion of Successful Online Learning and Orientation: Informatics Training (SOLO-IT)
modules. In a known group approach, “the instrument is administered to two groups known to
be high and low on the measured concept (Burns & Grove, 2010). This study will also determine
if self-perceptions of informatics competencies increased following completion of SOLO-IT’s
online training modules. Competency is indicated by a minimum SANICS score of 3 (Yoon et
al., 2009). If the SANICS is sensitive to individual differences in means (averages) before and
after completion of SOLO-IT, then the mean performance between each group should be
significantly different (Waltz, et al. 2005).
Responsiveness
Responsiveness is an index used to measure an instrument’s ability to detect change over
time between baseline and post-test (Middel & Van Sonderen, 2002). Responsiveness, or effect
size (ES), of the SANICS will be determined using a standardized response mean (SRM) which
is commonly used to measure responsiveness (2002). The SRM will be calculated as the
difference between scores before and after completing SOLO-IT, divided by the standard
deviation of the difference. Effects sizes of < 0.20 are commonly accepted as trivial
responsiveness; ES ≥ 0.20 < 0.50 small; ES ≥ 0.50 < 0.80 moderate; and ES ≥ 0.80 large (Cohen,
1977). Responsiveness of the scale over time will be assessed using independent sample t-tests.
19
Studies Describing Informatics Competencies
Staggers and colleagues established the standards for measuring informatics
competencies largely in use today (2001, 2002). This seminal work has served as the foundation
for studies which have followed, resulting in expanded competency descriptions for specific
populations. Despite the significant contributions by Staggers and colleagues which have
resulted in comprehensive competency descriptions, most nursing informatics research reports
still fail to define this concept (Hunter, McGonigle, & Hebda, 2013).
In a recent study (2011) of 350 nurses, more than two-thirds (69.2%) reported below
average informatics competency and over half (58.9%) rated computer skills as below average
(Hwang & Park). The ability to search databases and use nursing-specific software, both critical
information technology skills, were also reported as lacking by survey participants (2011). This
study positively correlated the presence of basic computer skills and formal informatics
education with informatics competency. Hwang and Park concluded accessibility to informatics
education, as well as training opportunities to improve basic computer skills, are needed in
nursing practice to improve the competencies necessary for managing and using healthcare
information, and improving patient safety (2011). Furthermore, the researchers recommended
that priority be given to groups possessing low computer proficiency (2011).
Another study exploring common practices employed by RNs when accessing data to
support evidence based practice (EBP) indicated a preference for information obtained from
colleagues rather than a review of scholarly literature (Dee & Stanley, 2005). The reason cited
for this preference was unfamiliarity with navigational skills necessary to access electronic
databases (2005). Opportunities to infuse technology into nursing education include access of
real-time linkages to expansive and widely available global information networks. Nursing
20
programs frequently focus on the use of technology as a means to support educational
programming rather than an essential tool to prepare students for technology enhanced nursing
practice (McNeil, Elfrink, Pierce, Beyea, Bickford, & Averill, 2005).
In further research conducted by McNeil and colleagues, college deans and directors
from 266 baccalaureate and higher nursing programs ranked their faculty’s ability to teach and
use nursing informatics as “novice” or “advanced beginner” (McNeil, et al., 2005). The study
revealed that United States (U.S.) nursing programs inconsistently taught information literacy
skills, standardized nursing language, and technology supported evidence based practice. Their
research examined informatics knowledge and skills taught in baccalaureate and master's level
nursing education programs in the U.S.. Findings from this study showed that only about half of
U.S. baccalaureate nursing programs (n=135) taught information literacy skills or required basic
word processing and e-mail skills for entering students. Only 25% (n=67) expected students to
enter their nursing program with information literacy skills and only 9% (n=24) expected
students to have the ability to use presentation software. The informatics content taught most
frequently included “accessing electronic resources” (50%), followed by “computer based
patient record” (46%), “ethical use of information systems” (45%), “informatics nurse
competencies” (40%), and “informatics definitions” (39%). Only 37% of respondents reported
teaching informatics content which supported evidence-based practice. Graduate programs were
found to have even less informatics related content areas than undergraduate programs. The
researchers also examined the perceptions of faculty members’ informatics competency and their
use of informatics tools. Almost half of respondents ranked nursing faculty abilities as “novice”
or “advanced beginners” with using nursing informatics applications. This study determined that
a critical need exists to “include informatics concepts, informatics skills, and the use of
21
informatics tools in professional nursing practice within nursing curricula across the US” and to
prepare faculty who are qualified to teach these skills (p. 1029). These findings have
implications for nursing education since the ability to access and translate informatics knowledge
is essential for evidence based nursing practice (IOM, 2011). Much work is needed to prepare
current and future generations of nurses to function as competent users of the information
technologies that support evidence based practice (Desjardins, Cook, Jenkins, Bakken, 2005;
Waters, Rochester, McMillan, 2012).
Frequently, a substantial amount of time passes between an initial nursing degree and a
return to higher education. This delay between nursing programs of study exacerbates the
problem of informatics deficiencies for nurses since technological changes in the educational
setting further illuminate a lack of understanding of informatics (Spratley, et al., 2000).
Many high functioning students (top 10% of incoming college freshman) capable of
performing internet based literature searches lack the ability to 1) access scholarly sources, 2)
think critically about the information attained, and 3) lack awareness of legal and ethical issues
relating to information technology (Gross & Latham, 2009). Consensus exists among deans and
directors of nursing programs across the nation that nursing students should graduate with basic
information literacy skills, though such skills are frequently not taught in undergraduate
programs (McDowell & Ma, 2007). Additionally, nurse educators frequently possess only basic
skills in the area of applied informatics (Skiba, Connors, Jeffries, 2008). Informatics training,
therefore, shifts to the employing institution and to nursing administrators who are left to manage
the lack of informatics training and the inadequate technological preparation of nurses (Westra &
Delaney, 2008). Because graduating nurses are prepared insufficiently with technology skills,
22
formalized informatics training which should have been provided during the post-secondary
educational process, is necessarily absorbed by the workplace, or is entirely absent (2008).
Information literacy (the ability to access, process, and use information) is the
recommended standard for nursing and nursing students (IOM, 2011). Nurse information
literacy skills must be highly efficacious to manage vast amounts of new information (Majid,
Foo, Luyt, Zhang, Theng, Chang, and Mokhtar, 2011). However, despite groundbreaking
technological advances in healthcare, nurses frequently lack basic informatics competencies
outside of their own work environment (Thede & Sewell, 2009). A survey of nurse executives
revealed the existence of a “preparation-practice” gap regarding technical readiness among
nursing graduates (Nurse Executive Center Nursing School Curriculum Survey [NECNSC],
2008). Only 10.4% of respondents felt that nursing graduates are being sufficiently prepared for
practice in the area of technical skills. This finding was followed with agreement by almost 90%
of the 362 nursing school leaders surveyed (2007).
Instruments Measuring Informatics Competencies
Since the arrival of computer systems to the healthcare setting, nurses have been urged to
obtain competency with using technology in all practice settings (Ball, Douglas, Hinton Walker,
2011). Experts and leading professional nursing organization have provided perspectives
regarding the need for all nurses to use and apply information technology in their practice (ANA,
2001; IOM, 2011; TIGER, 2008).
Nursing experts and professional organizations have called for a nursing workforce
capable of demonstrating informatics competencies. However, integration of informatics into
the nursing curriculum and development of informatics competencies among nurses is still
lacking (Hunter, McGonigle, Dee, Hebda, 2013; Virgona, 2013). While numerous informatics
23
competency instruments have been utilized, relatively few research reports provide psychometric
data to support the reliability and validity of the instruments (Lin, 2011). Issues related to
computer competency and information literacy have long been described by researchers, yet
“little attention has been paid to the validity of scales used” (Lin, 2011, p. 306).
The following discussion summarizes research reports describing informatics
competencies using a variety of instruments over the past decade. An outline of what is
currently known about instruments measuring nursing informatics competencies follows
(including their psychometric properties, when available). This information is also summarized
chronologically in Table 2, with studies using the SANICS instrument highlighted separately
toward the end of the table.
Graduating Nurses’ Self-Evaluation of Information Technology Competencies
The 43 informatics novice nurse competency items developed as part of the seminal work
by Staggers, Gassert, and Curran (2001) served as the foundation for the Graduating Nurses’
Self-Evaluation of Information Technology Competencies survey instrument (Fetter, 2009). In a
pilot study, informatics competencies were ranked by 42 graduating seniors. The majority of the
program’s graduating students rated themselves as having moderate ability on novice nurse
standardized competencies. Students self-reported strongest skills in computer based
communication and desktop software, and lowest competencies in the use of documentation
systems and valuing informatics knowledge (2009). Recommendations included integrating
information technology into all courses and establishing minimum performance standards for
each course. The project “lacked the rigor of formal research” since reliability data on how it
performed were not collected (2009).
24
Computer Literacy Scale for Newly Enrolled Nursing College Students
Lin (2011) described the reliability and validity of computer competency and computer
literacy scales used in nursing. Of the five survey tools included in the background evaluation,
only three included any basic reliability/validity data, and this information was limited (Bataineh
& Baniabdelrahman, 2006; Cole & Kelsey, 2004; Elder & Koehn, 2009; Lupo & Erlich, 2001;
McNeil, Elfrink, Beyea, Pierce, & Bickford, 2006). The researcher described the computer
literacy of Taiwanese nursing students using the Computer Literacy Scale for Newly Enrolled
Nursing College Students (2011). This assessment scale was developed based on the Ministry of
Education (MOE) guidelines. The resource was designed for technical schools and included
computer hardware, software, networks, computer problem solving and IT society (Hinkin,
1998). The content validity index (CVI) was tested using eleven experts who rated content
relevance (2011). Principal component analysis with varimax rotation was used to estimate total
variance, and Eigenvalues greater than one guided the total number of factors used. Exploratory
factor analysis confirmed the content validity and internal consistency of the instrument. The
researcher concluded the instrument had good content validity, reliability, convergent validity,
and discriminant validity, and was an “excellent computer literacy assessment for newly enrolled
nursing students” (p. 315).
Assessment Tool for Nursing Student Computer Competencies
The Assessment Tool for Nursing Student Computer Competencies is comprised of 40
self-ranking statements, designed by the researchers, to measure perceptions of computer
competency (Elder & Koehn, 2009). Students were offered a voluntary tutoring session on
computer skills as an incentive to participate in this study. The researchers compared computer
competency self-ratings of 79 first and second semester nursing students and 8 RN-BSN
25
completion students. Ratings were then compared with the actual performance of those skills on
a computer graded assessment. Reliability was computed using Kuder-Richardson 20 coefficient
of reliability, resulting in in an alpha of 0.65. Content validity, questions, and skills were derived
from concepts taught in a basic computer course. Correlation coefficients were computed for
survey and actual assessment scores which showed a low but significant correlation (r=0.282,
p<0.05). Results suggested that students self-rated computer skills higher than actual ability to
perform them (2009).
The eNNI Project
The Electronic National Nursing Informatics (eNNI) Project measured the electronic
documentation competencies of nurses and nurse educators before and after an educational
intervention designed to improve information and communication technology (ICT) skills
(Rajalahti & Saranto, 2012). A total of 158 Finnish nurse educators and novice-to-experienced
RNs took part in this study. An e-questionnaire was developed and used based on the
foundational work of Staggers, et al. (2002) and Saronto (1997) which itemized requisite
computer competency and information literacy skills. The psychometric properties of the e-
questionnaire instrument were not evaluated during this project. The researcher concluded that
informatics competencies of the nurse participants and educators did not improve as a result of
this project (2012).
Computer Competencies in the Curriculum
Ornes and Gassert (2007) used the beginning nurse competency items from Staggers’
(2001) earlier work to develop an informatics competency tool for beginning nurses. This tool
was used to evaluate baccalaureate nursing students’ information technology skills by
determining how informatics content was represented in the curriculum. Researchers determined
26
students were not routinely exposed to computerized systems in the class room and may not be
prepared to use IT. No syllabi addressed informatics knowledge competencies. Researchers
concluded that students received insufficient exposure to informatics and were at risk for being
insufficiently prepared to use information technology. Recommendations included increasing
exposure to nursing informatics within the BSN curriculum. No reliability/validity data was
provided for the instrument used in this study (Ornes & Gassert, 2007).
Survey of Beginning Nurse Competencies
Desjardins, Cook, Jenkins & Bakken (2005) evaluated the effect of an informatics
curriculum on nursing informatics competencies among undergraduate students using a modified
version of the tool developed by Staggers, et al (2001, 2002). The researchers used a repeated-
measures, non-equivalent comparison group design to measure differences in self-rated
informatics competencies before and after a curriculum on Informatics for Evidence Based
Practice (IEBP). Students were not competent in information literacy at the beginning of the
BS/MS Program, despite having a bachelor’s degree in another field. Significant increases were
reported from admission to graduation in most or all of the cohorts studied. Findings suggested
incorporating informatics into the curriculum was successful. However, all data was self-
reported, and information concerning the validity or reliability of the survey tool was not
provided (Desjardins, et al., 2005).
Computer Competencies Survey and Assessment Tool
Elder and Koehn (2009) observed undergraduate nursing students may perceive computer
skills to be higher than ability to perform them, suggesting that actual competencies may be even
lower than reported. The researchers compared the self-rated computer competencies among
incoming nursing students’ (n=87) with their ability to perform those skills on assessment. The
27
Computer Competencies Survey tool was developed by the researchers and included Likert-type
scale items asking students to rate themselves from expert to no experience. The survey was
followed by completion of the Computer Competencies Assessment, a 40 question computer-
graded assessment also created by the researchers. Correlation coefficients showed a low, but
significant correlation for the survey and assessment (r=0.282; p<0.05). No psychometric data
describing the reliability and validity of either tool was provided. Findings from this study
suggested that students frequently “did not have an adequate grasp of basic computer
knowledge”, as demonstrated by high self-ratings and low performance scores (Elder & Koehn,
2009).
Gassert/McDowell Computer Literacy Survey
McDowell and Ma (2007) surveyed 411 students on admission and 429 upon graduation
from a baccalaureate nursing program to compare differences in computer experience between
program entrance and exit. Significant increases in experience were noted with word processing,
e-mail, and Internet experience, but little improvement was noted in information literacy, or
advanced skills, such as spreadsheets and use of data bases. Results suggested that “nursing
education programs currently may not be providing beginning nurses with the tools needed to
effectively and efficiently work in the technology-rich healthcare arena” (2007, pg. 30). No
reliability or validity data was provided for the research instrument.
TIGER Initiative Informatics Competencies
The TIGER Initiative Informatics Competencies instrument was developed to measure
self-perceptions of nursing informatics competency (Hunter, McGonigle & Hebda, 2013). The
231 items on the instrument were selected from three other instruments already in existence
following three rounds of reviews by content experts. The basic-computer-skills items (108)
28
came from European Computer Driver License computer literacy course ( 2012). The
information literacy items (47) were adapted from the American Library Association's
Information-Literacy Standards (2012). The source of items for clinical information
management (76) came from the Health Level Seven electronic health-record-system functional
model (2004). Content Validity Index (CVI) was calculated on each subset of NI competencies
and demonstrated moderate validity: Information Literacy=1.0; Clinical information
Management=1.0; Basic Computer Skills=1.0. The instrument was piloted with 184 participants
ranging in age from 26-70 years (161 of the respondents were RNs). The majority of
participants ranked themselves as expert on most of items on the survey, with lesser confidence
on information literacy related items. Limited reliability/validity data was provided, as this
report focused on instrument development. The researchers stated an analysis of each item will
be forthcoming and reported in a future article (Hunter, McGonigle & Hebda, 2013).
Informatics Competency Questionnaire
Hwang & Park (2011) conducted a cross-sectional study among nurses in Seoul, Korea.
The 292 item questionnaire measured self-perceptions of informatics competency, basic
computer skills, attitudes toward computers and population. Informatics competency positively
correlated with basic computer skills and formal informatics education. The majority of nurses
(69.2%) rated informatics competencies below average and more than half (58.9%) rated
computer skills as below average. Content validity was examined by three informatics experts.
Principal component factor analysis with varimax rotation revealed factor loadings ranging from
.41 to .81. Based on principal component analysis, factors were considered to be in the
developmental stage. Study recommendations included enhancement of nursing curriculum with
informatics content which includes basic computer skills (Hwang & Park, 2011).
29
Technology Skills Assessment Survey
The Technology Skills Assessment Survey in an instrument developed by the researcher
to assess the self-perceptions of technology skills among graduate Registered Nursing students
(n=19) enrolled in their first semester of course work (Virgona, 2012). The survey tool included
two qualitative and ten quantitative items measuring nurses’ perceptions of current technology
skills and the barriers to using and learning new technologies. Students generally rated
themselves as novices with technologies (Word, Excel, HTML, Javascript, and online bill
payment) other than social media and smart phones. Technology skills were not seen as critical
when entering nursing, but critical for promotion. The major theme emerging from the
qualitative data was the lack of in-house technology training resources, and the perception that
certain technology skills were not valued by organizations (Virgona, 2012). Reliability and
validity data were not included in this research report.
Competency Assessment Tool
Choi and Zucker (2013) compared the informatics competencies of Doctor of Nursing
Practice (DNP) students enrolled in the post-BS track (n=68) with students enrolled in the post-
MS (n=64) using the Competency Assessment Tool. This 86 item instrument assessed 18 areas
of informatics competency in the categories of computer skills, informatics knowledge, and
informatics skills. The instrument was based on Staggers and colleagues competency statements
for the beginning and experienced nurse (2001, 2002) with additional items added on
information literacy (Bakken, et al, 2004 and Curran, 2003). The internal consistency
reliabilities of the instrument were high, with a Cronbach's alpha for all items of .98. The
Cronbach’s alpha for the three competency categories was: computer skills .97, informatics
knowledge .95, and informatics skills .93. Overall, students in the post-BS and post-MS tracks
30
were not competent in any of the three categories of informatics competency at the beginning of
their first semester in the DNP Program. However, statistically significant improvement was
observed in perceived informatics competencies in all three categories following a 14 week
online informatics course (p<.05). Recommendations included offering an informatics
curriculum to improve the informatics knowledge and competency skills of DNP students,
particularly computer skills for decision support (Choi & Zucker, 2013).
The SANICS
The Self-Assessment of Nursing Informatics Competencies Scale (SANICS) is the
instrument chosen for this study. The internal consistency reliabilities of the instrument are high.
The SANICS was developed to assess the informatics competencies of nursing students and
practicing nurses using a valid, reliable means of measurement. This instrument is primarily
based on the informatics competencies developed by Staggers and colleagues, for beginning and
novice level informatics users (Staggers, Gassert, & Curran, 2002). Additional items were added
to the SANICS to include standardized terminologies, evidence-based practice, and wireless
communications. The SANICS contains 30 items designed to measure informatics competencies
with descriptors ranging from 1 (not competent) to 5 (expert) (2009). The instrument was
initially tested on a sample of 336 students completing the baccalaureate portion of a combined
BS to MS Nursing program following an informatics curriculum. Exploratory principal
components analysis with oblique promax rotation extracted a five-factor structure which
explained 63.7% of the variance. Those factors were as follows: Basic Computer Knowledge
and Skills (Cronbach’s alpha = 0.94), Applied Computer Skills: Clinical Informatics (Cronbach’s
alpha = 0.89), Clinical Informatics Role (Cronbach’s alpha =0.91, Clinical Informatics Attitudes
(Cronbach’s alpha = 0.94), and Wireless Device Skills (Cronbach’s alpha = 0.90).
31
Responsiveness of the SANICS was supported by significantly improved scores following
completion of an informatics course.
The studies summarized below describe how the SANICS was used to measure
informatics competencies in nursing student populations. Data describing the psychometric
performance of the SANICS is included, where available.
Choi
The SANICS was the chosen instrument in a study to compare informatics competencies
of 131 nursing students in three undergraduate tracks: Traditional Pre-Licensure, RN to BSN,
and Accelerated BSN (Choi, 2012). Students from each group were found to differ significantly
in overall informatics competency (F(2, 92)=4.31, p=.02). The RN to BSN students were
significantly more competent (mean=3.21) than Traditional Pre-Licensure students (mean=2.82)
(p=.02). The SANICS showed high internal consistency reliabilities. Cronbach’s alpha for the
total scale was .95. Subscale alphas ranged from .93 for “Basic computer knowledge and skills”
to .89 for “Clinical informatics role” and “Wireless Device Skills”. The researcher recommends
future research to identify factors affecting informatics competency, such as age, gender, basic
computer skills, level of nursing experience, or formal informatics education (Choi, 2012).
Choi & De Martinas
The informatics competencies of 289 undergraduate and graduate students were
examined using the SANICS (Choi & De Martinas, 2013). The internal consistency reliabilities
of the instrument were high. The Cronbach’s alpha for each subscale was calculated for each of
the five factors, as follows: Basic Computer Knowledge and Skills (0.94); Applied Computer
Skills (0.90) Clinical Informatics Role (0.89); Clinical Informatics Attitudes (0.90); and Wireless
Device Skills (0.87). Overall, students were found to be competent in informatics: Graduate
32
students reported a higher informatics competency mean (3.23, SD = 0.70) than undergraduate
students (3.01, SD = 0.72) (t = 2.35, p = 0.02). Study findings indicate that students in both
programs were most confident in their basic computer skills and informatics attitudes. However,
students from both programs perceived themselves to be less competent in the areas of applied
computer skills and clinical informatics role.
Choi & Bakken
The psychometric properties of the SANICS were examined in nursing students attending
an undergraduate (n=131) and graduate (n=171) program. The five-factor structure of the
instrument was valid, and accounted for 69.38% of the variance. The Cronbach’s alpha was 0.96
for the total scale with subscales ranging from 0.94 for basic computer knowledge and skills to
0.84 for data/information management skills. The SANICS showed good responsiveness
(standardized response mean =0.99). Significant improvement in competency scores among
students with diverse demographic and educational backgrounds was demonstrated following
completion of an informatics course. Construct validity using a known group approach was
supported by significantly higher mean scores for graduate compared to undergraduate students.
Researchers concluded the SANICS is a psychometrically sound for nursing students with
diverse demographic and educational backgrounds.
33
Table 1
Informatics Competency Instruments
Name and Source of
Items
Researcher
and Year
# of
Items Population
Psychometric
Characteristics
Education or
Training
Intervention
Findings
Survey of Beginning
Nurse Competencies
Based on 43
beginning nurse
informatics
competencies
Staggers, et al
(2001, 2002).
Additional EBP
items added based on
a survey of directors
at Columbia
University
Bakken, et al. (2004)
Desjardins,
Cook, Jenkins
& Bakken
(2005)
39-44
items,
varied
by
survey
version
274 nursing
students
completing
year one of a
BS/MS
Program
No validity/
reliability data No
Intervention
Students were not
competent in
information
literacy at the
beginning of the
BS/MS Program,
despite having a
bachelor’s degree
in another field.
Significant
increases reported
from admission to
graduation in most
or all of cohorts
studied
Gassert/
McDowell Computer
Literacy Survey
McDowell & Ma
(2007)
McDowell &
Ma (2007)
11
840
admitted and
graduated
nursing
students over
an eight year
period
No validity/
reliability data
Matriculating
or completion
of nursing
program
curriculum
Statistically
significant
increases were
reported in
experience and
computer
ownership during
the eight year
study period
34
Computer
Competencies in the
Curriculum
Matrix
Based on Categories
of Informatics
Competency for the
Beginning Nurse
(Staggers, et al.
(2001, 2002).
Ornes &
Gassert
(2007)
Not
Provid-
ed
Tool
developed to
evaluate
informatics
competencie
s within
syllabi of 18
courses.
No validity/
reliability data
Not
Applicable
Students were not
routinely
exposed to
computerized
systems and may
not be prepared to
use IT.
No syllabi
addressed
informatics
knowledge
competencies
Graduating Nurses'
Self-Evaluation of
Computer
Competencies
Survey
Based on Staggers, et
al. (2001) novice
nurse competencies
Fetter (2009)
43
42
graduating
seniors
“Lacked the rigor
of formal research
since reliability data
were not collected”
No validity/
reliability data
No
Intervention
Majority of
graduating
students self-rated
as having
moderate ability
on novice nurse
standardized
competencies
35
Computer
Competencies
Survey
and
Computer
Competency
Assessment Tool
Both tools developed
by the researchers
Elder & Koehn (2009)
Elder &
Koehn (2009)
40
61 first and
second
semester
nursing
students and
RN-BSN
completion
students
Content validity,
questions, and skills
tested were derived
from textual
concepts used in a
basic computer
course.
Correlation
coefficients were
computed for
survey and
assessment scores
and showed a low
but significant
correlation (r =
0.282, p < 0.05).
Pre-test to
self-assess
current
computer
competency
followed by
computer
assessment of
ability to
perform skills
Results suggested
that students rated
their skills higher
than their actual
performance of
computer skills.
Limited reliability/
validity studies
Computer Literacy
Scale for Newly
Enrolled Nursing
Students
Based on Ministry of
Education (MOE)
course guidelines and
relevant literature on
computer literacy and
competency
(2008)
Lin (2011)
24
270 first year
undergrads
Used context
validity index
(CVI) to test the
content validity of
computer literacy
measurement items.
Confirmatory factor
analysis showed the
scale possessed
good content
validity, reliability,
convergentvalidity,
and discriminant
validity.
No
Intervention
Participants earned
the highest scores
for the network
domain
and the lowest
score for the
hardware domain
Appears to be an
excellent computer
literacy
assessment for
newly enrolled
nursing students
36
Informatics
Competency
Questionnaire
Designed by the
researchers
(Hwang & Park,
2011)
Hwang &
Park (2011)
40
292 hospital
nurses
Cronbach alpha
coefficient = .79;
Principal
component factor
analysis with
varimax rotation
revealed factor
loadings ranging
from .41 to .81.
Content Validity
was examined by
three informatics
experts.
No
intervention
More than two-
thirds felt they had
insufficient
informatics
competency and
more than half
rated computer
skills below
average.
Based on principal
component
analysis, factors
were considered to
be in the
developmental
stage.
The eNNI Project
e-questionnaire based
on Saranto (1997) and
Staggers, Gassert &
Curran's (2002)
informatics
competencies research
Rajalahti,
Saranto
(2012)
158
136 nurse
educators,
novice and
experienced
RNs, other
nurse
professionals
in Finland
No validity/
reliability data
Education
provided on
electronic
nursing
documenta-
tion and
information
communica-
tion
technology
(ICT)
The NI skills of
the participants
and educators did
not improve
during the project
No reliability/
validity studies
37
Technology Skills
Assessment Survey
Developed by the
researcher
Virgona (2012)
Virgona
(2012)
12
19 graduate
Registered
Nursing
students
enrolled in
first semester
of course
work
No validity/
reliability data
No
intervention
Students perceived
technology skills
as not critical
when entering
nursing but critical
for promotion.
Lack of training
resources were
identified as a
barrier
Competency
Assessment Tool
Based on Staggers
and colleagues
competency
statements for the
beginning and
experienced nurse
(2001, 2002) with
additional items
added on information
literacy (Bakken, et
al, 2004; Curran,
2003)
Choi, Zucker
2013
86
68 post-BS
compared to
64 post-MS
Cronbach's alpha
for all items was
.98.
The Cronbach’s
alpha for the three
competency
categories was:
computer skills .97,
informatics
knowledge .95, and
informatics skills
.93.
14 week
online
informatics
course
Students were not
informatics
competent at the
beginning of their
first semester.
Statistically
significant
improvement in all
categories reported
after completion of
informatics course.
The internal
consistency
reliabilities of the
instrument were
high.
38
TIGER Initiative
Competencies
Basic computer skills
(108) came from
European Computer
Driver License
(ECDL, 2012).
Information literacy
items (47) were
adapted from the
American Library
Association's
Information Literacy
Standards (2012).
Source for clinical
information
management (76)
came from Health
Level Seven
electronic health
record system
functional model
(2004).
Hunter,
McGonigle &
Hebda (2013)
231
184 ranging
in age from
26-70 years
Limited reliability/
validity studies
Content Validity
Index (CVI) was
calculated on each
subset of NI
competencies:
Information
Literacy = 1.0;
Clinical
information
Management = 1.0;
Basic Computer
Skills = 1.0.
No
Intervention
Focused on
instrument
development.
Analysis of
each item
to be reported
in future article.
39
Self-Assessment of Nursing Informatics Competency Scale (SANICS)
Self- Assessment of
Nursing Informatics
Competencies Scale
(SANICS)
Yoon, Yen & Bakken
(2009)
Primary source was
Staggers, et al., (2001,
2002) beginning and
experienced nurse
informatics
competencies
Yoon, Yen &
Bakken
(2009)
93
Combined
BS/MS
nursing
students in
2006-07
(N=336)
Principal component
analysis with oblique
promax rotation
extracted five
factors: clinical
informatics role
(α = .91), basic
computer knowledge
and skills (α =.94),
applied computer
skills: clinical
informatics (α =.89),
nursing informatics
attitudes (α =.94),
and wireless device
skills
(α =.90).
Informatics
curriculum
which
emphasized
informatics
tools to
support
patient safety
mindfulness
modeling and
monitoring
Preliminary
evidence exists for
the reliability and
validity of the
SANICS
Sample
dependent-
young with a high
level of basic
computer
knowledge and
skills
SANICS
Yoon, Yen & Bakken
(2009)
Choi (2012)
30
131 nursing
students
from three
tracks:
Traditional
Pre-
Licensure,
RN to BSN,
and
Accelerated
BSN
Cronbach’s alpha for
the total scale was
.95. Subscale alphas
ranged from .93 for
“Basic computer
knowledge and
skills” to .89 for
“Clinical informatics
role” and “Wireless
device skills”
No
intervention
RN to BSN
students were
significantly more
competent
(mean=3.21) than
Traditional Pre-
Licensure students
(mean=2.82)
(p=.02).
The SANICS had
high internal
consistency
reliabilities
40
SANICS
Yoon, Yen & Bakken
(2009)
Choi &
Bakken
(2013)
30
131
undergrads
171 post-
graduates
Cronbach’s alpha of
0.96 for the total
scale with
subscales ranging
from 0.94 for basic
computer
knowledge/skills to
0.84 for
data/information
management skills.
The SRM was large
(0.99) indicating the
SANICS was
responsive
14-week
online
informatics
course
Construct
validity using a
known group
approach
was supported by
significantly
higher mean
scores
for graduate
students compared
to undergraduate
students.
The SANICS is
psychometrically
sound for nursing
students with
diverse
demographic and
educational
backgrounds
41
SANICS
Yoon, Yen & Bakken
(2009)
Choi & De
Martinas
(2013)
30
289
undergrad
and graduate
students
Cronbach’s alpha for
each subscale is
below:
Total (= 0.96)
Basic computer
knowledge and skills
( 0.94); Applied
computer skills
(0.90) Clinical
informatics role
(0.89); Clinical
informatics attitude
(0.90); Wireless
device skills (0.87)
No
intervention
Students were
competent in
informatics.
Graduate students
reported a higher
informatics
competency mean
(3.23, SD = 0.70)
than
undergraduate
students (3.01, SD
= 0.72) (t = 2.35, p
= 0.02).
The internal
consistency
reliabilities of the
instrument were
high
42
Informatics Training and Assessment
The Technology Informatics Guiding Educational Reform (TIGER) Collaborative issued
a Call to Action requesting education and training interventions which foster information
technology innovation and adoption by nurses (2008). Essential skills for clinicians were
identified as basic computer competencies and information literacy (2008). While the need for
improved informatics competencies has been well established for more than 25 years (Ball,
1984; Graves, 1989; Herbert, 1999; Saba & McCormick, 1996; Scholes & Barber, 1980;
Staggers, Thompson, Happ & Bartz, 1998; Turley, 1996), there remains a lack of training
resources for nurses (Ball, et. al, 2011). Informatics competency is also essential for students
enrolled in web based and web enhanced coursework commonly used to deliver nursing
education (Virgona, 2013). Education and training interventions described in the literature are
typically limited to informatics content modification for a single course (Bakken, Sheets, Cook,
Curtis, Soupios, Curran, 2003), or curricular revisions which measure informatics competency
from program entry to program exit (McDowell & Ma, 2007). Research has consistently
supported the effectiveness of courses which address the lack of informatics competencies of
nursing students (Choi & Bakken, 2013; Desjardins, Cook, Jenkins & Bakken, 2005; Shorten,
Wallace & Crookes, 2001; Tarrant, et al, 2008; and Wallace, Shorten, Crookes, McGurk, &
Brewer, 1999). Unfortunately, only half of nursing programs teach information literacy skills
(McNeil, et al., 2005; Pilarski, 2011).
Nurses work in complex, fast paced environments where they must quickly process data
and form clinical judgments which ultimately guide patient care (Kossman, Bonney & Kim,
2014). Universal adoption of informatics competencies will require access to on-demand
training resources available “at any time and from any site” (Ball, et al., 2011, p. 445).
43
Educational strategies limited to the occasional informatics course, or initiative which require
matriculation through an entire nursing program are insufficient and inadequate to meet the
growing informatics competency needs of busy nurses in practice, or a technologically
dependent nursing profession as a whole (Ball, et al., 2011).
A comprehensive review of the literature was conducted for training interventions which
used instruments to measure informatics competencies (computer skills and/or information
literacy) following a training intervention. This review identified a lack of web based training
resources and accompanying instruments to measure outcomes resulting from the delivery of
informatics training. Due to the paucity of empirical studies, the search for informatics training
resources for nurses with valid/reliable instruments was expanded to include 1) works published
since 1995, and 2) published resources/tools used in general education to measure computer
competency or information literacy before and/or after informatics training. These results
yielded only eight such informatics training resources in the scholarly literature or via public
access. Of these resources, only two included measurement tools. Review of curriculum-based
informatics instruction and/or health record simulation training sites was excluded from this
search. Training resources identified by this review are described in the following discussion,
and summarized in Table 2.
European Computer Driver’s License (ECDL) Certification
The Task Force of the Council of European Professional Informatics Societies (1997-
2014) developed the European Computer Driver’s License (ECDL) Certification Program as a
way to promote standardization of information technology skills within the IT industry and for
the general population. The subscription based ECDL online modules include computer
essentials, online essentials, word processing and spreadsheets. Additional training options (fee
44
based) include presentations, using databases, web editing, image editing, project planning, IT
security, online collaboration, and heath information storage. The TIGER Informatics
Competencies Team offered their endorsement of the ECDL and recommends training for nurses
using the Basic Computer Competencies Modules. The ECDL is the world’s largest end-user
computer skills certification program, has been used by more than 7 million users, and has “a
very well developed and mature training program, work book, and testing process” (TIGER,
2008). The ECDL’s Basic Computer Competency training is comprised of the seven modules
outlined below:
Module 1 – Concepts of Information Technology (IT)
Module 2 – Using the Computer and Managing Files
Module 3 – Word Processing
Module 4 – Spreadsheets
Module 5 – Database
Module 6 – Presentation
Module 7 – Information and Communication
While ECDL training is endorsed by the TIGER Collaborative, its modules are
generalized for use in a wide range of industries and do not address essential computer skills
required in healthcare, or the unique challenges of the healthcare setting (eg. HIPAA, meaningful
use, interoperability, etc.). Validity and reliability measurements for the tools used for ECDL
assessments are not available online, and were refused upon request of this researcher.
TIGER Virtual Demonstration Center
As mentioned above, the TIGER Collaborative has recommended the ECDL program as
a computer competency training option for nurses (2008). However, a new subscription based,
45
Virtual Demonstration Center (2013) sponsored by the TIGER Collaborative, was recently
launched as a virtual conference, simulation and training site for nurses. The Demonstration
Center contains web based informatics resources, including links to clinical simulations, as well
as observable and interactive demonstrations. Links are embedded within the Center’s web
pages allowing users to navigate to other sites which support the development of informatics
competencies. Access to the Center also includes webinars and educational sessions covering
electronic health records, usability, clinical decision support, meaningful use, health information
exchange, and interoperability. The vision of the TIGER Virtual Demonstration Center is to
provide “highly effective and efficient, technology-enabled, solutions of exemplary healthcare
delivery systems of the next three to ten years” (2013). An online instrument, (The TIGER
Online Self-Assessment Tool) has been designed and piloted which measures self-perceptions of
informatics competencies. This instrument has demonstrated moderate content validity (Hunter,
McGonigle & Hebda, 2013).
Nursing Resources: A Self-Paced Tutorial and Refresher
An online training resource entitled “Nursing Resources: A Self-Paced Tutorial and
Refresher” is available via open source through New York University’s (NYU’s) Library
(Jacobs, 2014). The site includes four self-paced online modules covering the following topics:
Beginner’s Research Guide – Literature search, locating articles, background questions,
Search strategies, citing, and locating full text articles.
Evidence Based Nursing- Locating the best evidence, developing the research question,
expanding the search for evidence, specialized databases, and clinical guidelines.
Web Resources – Searching the web, search engines, web directories, consumer health
information, and evaluating the web.
46
Tools – Saving search histories
Learners move through the site using navigational arrows at the bottom of each page.
The site is not interactive and skill demonstrations, or the use of assessments or evaluation
tools, are not options on this site.
IC³ Training and Certification Program
The IC³ Training and Certification Program is available online through Pearson Vue
Business (2000). The site targets incoming college students who may need computer
remediation or employers who may wish to use its assessment capabilities as a screening tool for
new job candidates. Certification comprises individual examinations for computing
fundamentals, key applications (word processing, spreadsheet and presentation software), and
living online (internet and networking). A convenience feature found on this site is the “IC³ Fast
Track” which allows literacy skills to be quickly assessed. This resource is only available
commercially, with an option to purchase bulk user licenses. Certification is achieved through
successful completion of a “one time test. Approximately 175,000 examinations are
administered monthly in 148 countries and in 27 languages. Benefits of IC³ certification are
described as a means to “validate digital literacy skills”, although no published data regarding
the site’s effectiveness, or the psychometric properties of instrument could be located. Pearson
Vue denied requests by this researcher to provide data describing the performance of the training
site or assessment tool.
The Passport Project for Nursing Success
The purpose of the Passport Project for Nursing Success was to “assess the skills,
knowledge, and informatics comfort level of students, while providing computer training and
teaching for beginning nursing students in an undergraduate nursing program” (Edwards &
47
O’Connor, 2011). A survey was created by the researchers since “no tools with measured
reliability and validity were available upon a review of the literature” (p. 5). The survey was
administered to incoming students’ (n=90) to measure self-perceived informatics competencies
and learning needs. Following this initial assessment, students completed seven self-paced
online learning modules housed in the Blackboard LMS. On-line tutorials with questionnaires
and demonstration assignments were incorporated into the modules to facilitate learning needs of
the students. These modules included:
Module 1: Basic Computing
Module 2: Nursing Program Handbook
Module 3: College Orientation & Resources
Module 4: Netiquette
Module 5: Managing Documents
Module 6: Research & APA
Module 7: On-line Testing
Evaluation of learning was based on the ability to perform various functions, including
complete an interactive evaluation, construct and download a document, and using the quiz
function within Blackboard. Five qualitative program evaluation questions yielded themes of
appreciation for the training, and improved understanding of informatics and Blackboard. No
reliability/validity data was available for any of the quantitative assessments used by the
researchers. While the Passport Project was described in the literature by the authors, the actual
site was not available for review.
48
Computer Competencies Tutorial
St. Edward University’s Computer Competencies Tutorial (1995-2007) is a web based,
computer skills remediation tool for all incoming freshmen. Completion of this training was
required during the years 1995-2007, but became optional during the years 2008-2011.
Descriptions of this online computer training resource are provided here for completeness only,
as the Tutorial was removed as an active training site in 2013. No assessment instrument was
used to measure the effect of training. The Computer Competency Tutorial consisted of five
modules covering the following content:
1.) Introduction to Computers
2.) World Wide Web
3.) Introduction to Word Processing
4.) Introduction to Spreadsheets
5.) Multimedia
Information Literacy Tutorial
The open source Information Literacy Tutorial, sponsored by Rutgers University, is a
web based training site for nursing students (2008). This tutorial consists of three sections
covering animated and/or video recorded content intended to improve information literacy. The
Tutorial’s content includes: formulate a research question, navigate CINAHL and Medline, find
full-text articles, and employ RefWorks to store reference sources and produce bibliographies in
proper APA format. The site is not interactive, requires no assignments, and uses no instrument
to measure outcomes.
49
Pre-test for Attitudes Toward Computers in Healthcare (PATCH)
The Pre-test for Attitudes Toward Computers in Healthcare (PATCH) is an open source,
online tool for self-assessment of general nursing informatics competencies (Kaminski, 2011).
Modules on the site provide information, links, and self-assessment checklists for a variety of
computer based tasks. Attitudes regarding various computer skills are measured via an online
survey, covering the following competency items: Word processing, keyboarding, spreadsheets,
presentations, databases, desktop publishing, internet, e-mail, expert and decision support
systems, multimedia, web development, telecommunications, nursing information systems,
hospital information systems, peripherals, PDAs, nursing data and information, current computer
literacy, life-long learning, computer-human interface dynamics, networking, basic computer
configurations, protection for client data & information, and evidence based practice. A study of
Turkish nurses (n=200) was conducted to assess the validity and reliability of the PATCH Scale
(Kaya & Turkinaz, 2008). Test-retest reliability was 0.20-0.77 and 0.85 for the total scale. Item
total correlation was 0.06-0.68 and Cronbach's Alpha was 0.92 (2008).
50
Table 2
Non-Curricular Informatics Training Resources
Training
Site/
Resources
Author(s) Delivery
Method
Population Description of
Training
Pre/Post
Tests
Site
European
Computer
Driver
License
(ECDL)
Certifica-
tion
Council of
European
Prof.
Informatic
s Societies
(1997-
2014)
Developed
the
certification
program as
an online
way of to
promote
information
technology
skills
General
population
and skill
standardizati
on within
the IT
industry.
ECDL base
modules include
computer
essentials, online
essentials, word
processing and
spreadsheets.
ECDL Standard
add on options
include
presentations,
using databases,
web editing,
image editing,
project planning,
IT security, online
collaboration, 2D
CAD and Heath
Information
Storage.
Not
available
http://www
.ecdl.org/pr
ogrammes/i
ndex.jsp?p
=2931&n=
2954
Passport
Project for
Nursing
Success
Edwards,
J. &
O'Connor,
P.
(2011)
7 self-paced
online
learning
modules
housed in
Blackboard
Incoming
nursing
students
n=90
On-line tutorials
with
questionnaires and
demonstration
assignments to
facilitate learning
needs of the
students.
1: Basic
Computing
2: Nursing
Program
Handbook
3: College
Orientation &
Resources
“No tools
with
measured
reliability
and validity
were
available
upon a
review of
the
literature”
Five
program
evaluation
questions
http://www
.thejeo.com
/Archives/
Volume8N
umber2/Ed
wardsandO
ConnorPap
er.pdf
51
4: Netiquette
5: Managing
Documents
6: Research &
APA
7: On-line Testing
only.
Pretest for
Attitudes
Toward
Computers
in
Healthcare
(PATCH)
Self-
Assessment
Tool
Kaminski
(2011)
An online
tool for self-
assessment in
general
nursing
Informatics
competencies
. Various
competency
taxonomies
have been
reviewed and
integrated in
the process.
Registered
Nurses
N=200
Turkish
nurses
Modules Include:
Word Processing,
Keyboarding,
Spreadsheets,
Presentations,
Databases,
Desktop
Publishing,
Internet, Email,
Decision Support
Systems,
Multimedia, Web
Development,
Telecommunicatio
ns, Nursing
Information
Systems, Hospital
Information
Systems,
Peripherals,
PDAs, Data and
Information,
Computer
Literacy, Life
Long Learning,
Computer-Human
Interface and EBP
Test-retest
reliability
was 0.20-
0.77, for the
total scale
was 0.85.
Item total
correlation
was 0.06-
0.68 and
Cronbach's
Alpha was
0.92.
http://nursi
ng-
informatics
.com/niasse
ss/plan.htm
l
Nursing
Resources:
Self-Paced
Tutorial
and
Refresher
Kaplan
(2014).
New York
University
Online
instructional
tool
consisting of
4 modules
Nursing
Students
This tutorial
encompasses a
beginner's
research guide,
web resources,
tools, and
evidence based
practice only.
No
instrument
http://nyu.li
bguides.co
m/nursingt
utorial
Certiport
IC³
Internet and
Pearson
Vue
Business
One hour
online
competency
Incoming
college
students or
IC³ Fast Track can
be used to gauge
digital literacy
One-time
fee based
test
52
Computing
Certifica-
tion
(2000) test screening
tool for new
job
candidates.
175,000
exams
administere
d monthly in
148
countries
and 27
languages
skills.
Certification
comprises
individual
examinations for
computing
fundamentals,
key applications
(word processing,
spreadsheet and
presentation
software), and
living online
(internet and
networking )
No
published
data
No data on
psychometri
c properties
of
instrument
https://ww
w.certiport.
com/portal/
common/d
ocumentlib
rary/IC3_G
S4_Progra
m_Overvie
w.pdf
Information
Literacy
Tutorial
Rutgers
University
Library
(2008)
3 online
sections
Nursing
Students
Tutorial:
Used to formulate
a research
question, navigate
CINAHL and
Medline, find full-
text articles, and
employ RefWorks
to store reference
sources and
produce
bibliographies in
proper APA
format
No
instrument
http://www
.libraries.ru
tgers.edu/r
ul/rr_gatew
ay/research
_guides/nur
sing/tutoria
l/
Computer
Competenc
y Tutorial
St.
Edward's
University
(1995-
2011)
5 self-paced
online
modules
Incoming
freshmen
requirement
until 2009.
Currently
optional
Five Modules:
1.) Introduction to
Computers
2.) World Wide
Web
3.) Introduction to
Word Processing
4.) Introduction to
Spreadsheets
5.) Multimedia
Inactive
Test Link
No
instrument
http://acade
mic.stedwa
rds.edu/co
mpetency/
module2/L
esson1/ww
wandintern
tgetconnect
ed.htm
The TIGER
Online Self-
Assessment
53
The TIGER
Virtual
Demonstrat
ion Center
TIGER
and
Hunter,
McGonigl
e &
Hebda,
(2013)
Web based
conference
and
simulation
center
Nurses and
nursing
students
Web based
informatics
resources,
including links to
simulations, as
well as observable
and interactive
demonstrations
Tool-
designed
and piloted;
measures
self-
perceptions
of
informatics
competency;
moderate
content
validity
http://www
.thetigerinit
iative.org/v
irtuallearni
ng.aspx
Summary
For more than 30 years, authoritative nursing bodies have urged the nursing profession to
strategically address informatics competency for all nurses. Despite persistent recommendations
from the ANA, AACN, NLN, TIGER and IOM regarding the critical need for an informatics
competent nursing workforce, nurses still frequently lack essential informatics competencies,
including basic computer skills. Evidence based practice depends upon ability to use and apply
information technology skills, such as searching data bases and using nursing-specific software.
Studies of nurse executives and academicians describe a nursing profession which remains
insufficiently prepared with basic informatics skills upon entry to practice. Research supports
the effectiveness of courses which address the lack of informatics competencies of nursing
students, with recommendations that priority be given to groups possessing low computer
proficiency. Unfortunately, nursing programs have been slow to incorporate information literacy
skills into the curricula. Informatics training programs which could support nurses in practice
are sparse in the literature. Curriculum based instruction alone is no longer sufficient for nurses
attempting to keep pace in a fast paced technology-rich healthcare environment. Finally, this
review identified few or insufficiently validated instruments which could be used to measure
54
empirical outcomes resulting from delivery of nursing informatics training. The sparse number
of empirically supported informatics training resources and evaluative tools is inconsistent with
recommendations from official nursing and health organizations calling for a deliberate,
systematic approach to improve the basic computer skills and information literacy of the nursing
profession.
The SANICS has become a nationally recognized instrument with numerous empirical
studies attesting to its internal consistency reliability, responsiveness, and factorial validity
(Choi, 2012; Choi & Bakken, 2013; Choi & De Martinas, 2013). Studies of the SANICS to date
have focused on a variety of nursing student populations engaged in curriculum based
instruction. However, no studies to date have examined the effectiveness of the SANICS
instrument when used in a population of undergraduate nursing students before and after a self-
directed, web-based, informatics training program, such as SOLO-IT.
Curriculum-based instruction alone is no longer sufficient for nurses attempting to keep
pace in a fast paced technology-rich healthcare environment. Diffusion of informatics
competencies throughout the nursing workforce could depend upon the availability and usability
of on-demand training resources focused on the needs of the self-directed learner. Further
testing is necessary to examine the psychometric properties of the SANICS in a sample of BSN
entry-level nursing students. Principal component analysis will be used to examine the factor
structure of the SANICS. Internal consistency reliability will be used to determine if the
SANICS is responsive over time when used to measure informatics competencies.
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Chapter III
Research Methodology
Introduction
A comprehensive search of informatics training resources revealed a significant gap in
the literature regarding the availability of these resources, and a lack of valid, reliable tools to
measure informatics competencies. This study will use psychometric analyses as a means to
quantify the precision of the Self-Assessment of Nursing Informatics Competency Scale
(SANICS). The psychometric performance of the SANICS will be evaluated before and after
completion of Successful Online Learning and Orientation: Informatics Training (SOLO-IT) for
nursing students. Principal component analysis will be used to examine the factor structure of
the SANICS. Internal consistency reliability will be used to determine if the psychometric
properties of the SANICS remain consistent in a sample of BSN entry-level nursing students and
if the SANICS is responsive over time when used to measure informatics competencies. This
study will also evaluate the mean rating differences of the SANICS instrument before and after
completion of SOLO-IT. Construct validity of the SANICS will be assessed using a known
group approach to compare differences in means for each SANICS subscale (construct) before
and after completion of SOLO-IT modules.
Research Questions
1) What are the psychometric properties of the SANICS among a population of BSN
entry-level students?
2) Is the SANICS responsive over time when used to measure informatics competencies
following completion of Successful Online Learning and Orientation (SOLO)
Informatics Training (IT) modules?
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Hypothesis: There will be a significant difference in SANICS scores between
pre-SOLO and post-SOLO.
Research Design
Successful Online Learning and Orientation: Informatics Training (SOLO-IT) is a web
based remediation tool designed and created by the researcher to enhance the informatics
competencies (computer skills and information literacy) of nursing students (Godsey, 2011).
Online modules were designed to be self-guided and self-paced to allow nursing students to
learn, practice and demonstrate informatics competencies using common technological tools
embedded into the Blackbord ™ learning management system (Godsey, 2011). This study will
explore the psychometric performance of the SANICS instrument using archived survey data
collected before and after completion of SOLO-IT. A one-group pre/post-test design using the
30-item SANICS was utilized in a sample of undergraduate nursing students. The survey design
provides a “quantitative or numeric description of trends, attitudes, or opinions of a population
by studying a sample of that population” (Creswell, 2009, p. 145). Surveys comprised of
competency items contained within the SANICS instrument were administered via Survey
Monkey to student volunteers prior to and at the completion of SOLO-IT. Permission to use the
SANICS (2009; Appendix A) was requested and granted by Dr. Yoon and colleagues.
Conceptual Definitions
Informatics
The ANA defines nursing informatics as “a specialty that integrates nursing science,
computer science, and information science to manage and communicate data, information, and
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knowledge in nursing practice” (2008, p. 177). The ANA’s (2001) position statement also
describes the relevance of informatics to nursing practice:
Nursing informatics facilitates the integration of data, information, and knowledge to
support patients, nurses and other providers in their decision-making in all roles and
settings. This support is accomplished through the use of information, information
processing, and information technology (p.17).
Informatics Competency
Staggers and colleagues made a significant contribution in the area of nursing informatics
when they defined the competencies, skills, knowledge, and abilities necessary for nurses based
on educational preparation and expertise: beginning nurse, experienced nurse, informatics nurse
specialist, and informatics innovator (Staggers, Gassert, & Curran, 2002). Since the present
study concerns measurement of nursing informatics competencies among undergraduate nursing
students, the following discussion of informatics competency (informatics knowledge and
computer skills) is limited to the beginning nurse only.
Informatics Knowledge. Informatics knowledge needed for nurses at the beginner level
has been categorized into data, impact, privacy/security, and systems information and is
described below (Staggers, Gassert, & Curran, 2002).
1. Data
• Recognizes the use and/or importance of nursing data for improving practice
2. Impact
• Recognizes that a computer program has limitations due to its design and capacity
of the computer
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• Recognizes that it takes time, persistent effort, and skill for computers to become
an effective tool
• Recognizes that health computing will become more common
• Recognizes that the computer is only a tool to provide better nursing care and that
there are human functions that cannot be performed by computer
• Recognizes that one does not have to be a computer programmer to make
effective use of the computer in nursing
3. Privacy/security
• Seeks available resources to help formulate ethical decisions in computing
• Describes patients' rights as they pertain to computerized information
management
4. Systems
• Recognizes the value of clinicians' involvement in the design, selection,
implementation, and evaluation of applications, systems in health care
• Describes the computerized or manual paper system that is present
• Explains the use of networks for electronic communication (e.g., Internet)
• Identifies the basic components of the current computer system (e.g., features of a
PC, workstation. (p.3)
Computer Skills. Staggers and colleagues outlined beginner level computer skills in the
competency categories of administration, communication, data access, documentation,
education, monitoring, basic desktop software and systems skills (2002). A beginner level
computer competent nurse possesses the following skills:
1. Administration
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• Uses administrative applications for practice management (e.g., searches for
patient demographics, billing data)
• Uses applications for structured data entry (e.g., patient acuity or classification
applications)
• Communication (email, internet, telecommunications)
• Uses telecommunication devices (e.g., modems or other devices) to communicate
with other systems (e.g., access data, upload, download)
• Use e-mail (e.g., create, send, respond, use attachments)
• Uses the Internet to locate, download items of interest (e.g., patient, nursing
resources)
• Data access
• Uses sources of data that relate to practice and care
• Accesses, enters, and retrieves data used locally for patient care (e.g., uses HIS,
CIS for plans of care, assessments, interventions, notes, discharge planning)
• Uses database applications to enter and retrieve information
• Conducts on-line literature searches
• Documentation
• Uses an application to document patient care
• Uses an application to plan care for patients to include discharge planning
• Uses an application to enter patient data (e.g., vital signs
• Education
• Uses information management technologies for patient education (e.g., identifies
areas for instruction, conducts education, evaluates outcomes, resources)
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• Monitoring
• Uses computerized patient monitoring systems
• Basic Desktop Software
• Uses multimedia presentations
• Uses word processing
• Demonstrates keyboarding (typing) skills
• Systems
• Uses networks to navigate systems (e.g., file servers, www)
• Operates peripheral devices (e.g., bedside terminals, hand-helds)
• Uses operating systems (e.g., copy, delete, change directories)
• Uses existing external peripheral devices (e.g., CD-ROMs, zip drives)
• Uses computer technology safely
• Is able to navigate Windows (e.g., manipulate files using file manager, determine
active printer, access installed applications, create & delete directories)
• Identifies the appropriate technology to capture the required patient data (e.g.,
fetal monitoring device)
• Demonstrates basic technology skills (e.g., turn computer off & on, load paper,
change toner, remove paper jams, print documents)
(pp. 1-2).
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Operational Definitions
Entry Level Nursing Student
For the purpose of this study, an entry level nursing student is defined as any student
enrolled in the first year (first or second semester) of a traditional Baccalaureate of Science in
Nursing (BSN) program. Students enrolled in the Registered Nurse to Masters of Science in
Nursing (RN to MSN) Program were excluded from data collection procedures.
Blackboard™. The Learning Management System (LMS) used to house SOLO-IT is
called Blackboard. A LMS uses web-based technologies to plan, organize and deliver on-
demand course content and also assess student performance and learner outcomes (Blackboard,
2004). Blackboard is one of the most popular LMSs nationally (Bradford, Porciello, Balkon, &
Backus, 2007; Ferrin, 2013), and was the system of choice for the mid-western university which
approved the conduct of this research and the completion of SOLO-IT by their BSN student
population.
Curricular Instruction. Informatics specific content provided as part of a nursing
school’s curriculum. This type of instruction typically occurs as part of a didactic course and
lasts for the duration of an academic semester or quarter. Curricular instruction may also refer to
informatics content delivered during the time of the student’s matriculation through the nursing
program, not limited to a single course.
Informatics Training. Informatics training refers to delivery of informatics content and
instruction as part of a brief, intensive, episodic program designed to increase the informatics
competencies of participants. Informatics training typically involves self-directed learning and
interactive teaching strategies which engage the learner to demonstrate competencies.
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Competency on the SANICS. The SANICS instrument uses a Likert Scale ranging
from 1 (not competent) to 5 (expert). Self-perceived competence is indicated by a minimum
SANICS score of 3 (Yoon et al., 2009).
Instrumentation
The SANICS was developed by researchers out of Columbia University School of
Nursing (Yoon, et al, 2009; Appendix A). Development of this tool evolved primarily from a
Delphi Study conducted by Staggers and colleagues which incorporates competencies for the
beginner and experienced nurse (Staggers, Gassert & Curran, 2001). Additional items were
added to the SANICS by the researchers in areas relating to standardized nursing terminologies,
evidence based practice, and wireless communications (2009). The reliability and validity of the
SANICS has been established using a combined sample of 337 BSN/MSN students (Yoon, et.al,
2009). Cronbach’s α measurements confirmed the internal consistency of related items within
the scale. None of the inter-item correlations was less than α = .89. Reliability coefficients of .70
or higher are usually considered acceptable by most researchers (Bruin, 2006). Independent t-
tests confirmed the responsiveness of the SANICS over time and also measured the five
categorical factors of the scale: 1) Clinical Role, 2) Basic Computer Knowledge, 3) Applied
Computer Skills, 4) Clinical Informatics Attitudes, and 5) Wireless Device Skills. The sub-
scales and individual items contained within the SANICS instrument are described below:
1. Clinical informatics role
• As a clinician (nurse), participate in the selection process, design, implementation and
evaluation of systems
• Market self, system, or application to others
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• Promote the integrity of and access to information to include but not limited to
confidentiality, legal, ethical, and security issues
• Seek resources to help formulate ethical decisions in computing
• Act as advocate of leaders for incorporating innovations and informatics concepts into
their area of specialty
2. Basic computer knowledge and skills
• Use telecommunication devices
• Use the Internet to locate, download items of interest
• Use database management program to develop a simple database
• Use database applications to enter and retrieve information
• Conduct on-line literature searches
• Use presentation graphics to create slides, displays
• Use multimedia presentations
• Use word processing
• Use networks to navigate systems
• Use operating systems
• Use existing external peripheral devices
• Use computer technology safely
• Navigate Windows
• Identify the basic components of the computer system
• Perform basic trouble-shooting in applications
3. Applied computer skills: Clinical informatics
• Use applications for diagnostic coding
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• Use applications to develop testing materials
• Access shared data sets
• Extract data from clinical data sets
4. Clinical informatics attitudes
• Recognize that health computing will become more common
• Recognize human functions that cannot be performed by computer
• Recognize that one does not have to be a computer programmer to make effective use of
the computer in nursing
• Recognize the value of clinician involvement in the design, selection, implementation,
and evaluation of applications, systems in health care
5. Wireless device skills
• Use wireless devices to download safety and quality care resources
• Use wireless devices to enter date
Method to Test the SANICS Instrument
As described previously, the TIGER Collaborative has issued a call to action urging
improved informatics competencies, increased educational resources, and affordable programs
which foster information technology innovation and adoption by nurses (2008). In response to
this call, TIGER urges the development of competency based training strategies utilizing pre-
and post- test data as measure of effectiveness in meeting competencies (Ball, et al, 2008).
Successful Online Learning and Orientation: Informatics Training (SOLO-IT) is a web
based remediation tool designed and created by the researcher to enhance and measure the
informatics competencies (computer skills and information literacy) of nursing students (Godsey,
2011). Online modules were designed to be self-guided and self-paced to allow nursing students
65
to learn, practice and demonstrate informatics competencies using common technological tools
embedded into the Blackboard ™ LMS (Godsey, 2011).
Sample. The sample for this study will be taken from archived data collected from a
population of 271 entry level nursing students during the Spring 2014 semester. All students
enrolled in the first year of the Baccalaureate of Science in Nursing (BSN) Program were
enrolled into SOLO-IT as a required assignment for most sections of an entry-level nursing
course. Students were instructed to complete SOLO-IT’s six modules during the first two weeks
of the semester in order to prepare for web enhanced instruction. The location for this study was
a medium sized, private university located in Cincinnati, Ohio with an enrollment of 6700
students, including 637 nursing students. Entry level nursing students were selected as the
population for this study since they may be at risk for lacking the informatics competencies
necessary to support and enhance their nursing education. Additionally, this population of
students will have had minimal exposure to nursing informatics or the Blackboard learning
management system (LMS) which houses course content and provides the educational
framework for program matriculation.
SANICS and SOLO-IT
Each competency measured by the five sub-scales of the SANICS has been incorporated
(either specifically or broadly) into the six educational modules of SOLO-IT. The SANICS was
administered as an analytical survey to measure self- perceptions of informatics competency
(Yoon, et al., 2009; Appendix A). Analytical surveys “go beyond simple description; their
intention is to illuminate a specific problem through focused data analysis, typically by looking
at the effect of one set of variables upon another set” (Kelley, et al, 2003). An advantage of
survey research is that it allows for the production of empirical data resulting from “real-world”
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situations (Kelley, et al., 2003, p. 261). Survey research can also produce a large amount of data
within a relatively short amount of time. Data resulting from representative samples can be
generalizable to other populations (2003). Certain disadvantages can also be present with survey
research. Response rates may be difficult to control, and data may lack detail or sufficient depth
(2003).
The SANICS survey was administered before and after completion of SOLO-IT. The
post survey also included Likert scale items, developed by the PI, measuring the experiences of
learners taking the course, and evaluations of overall course quality. Completion of SOLO-IT
also included successful submission of informatics assignments within the Blackboard ™ LMS.
Each module included quizzes and/or hands-on activities requiring actual demonstrations of
computer competency and information literacy skills. To demonstrate competency, students
were required to complete SOLO-IT with a minimum score of 92%, with no limit in the number
of times students could repeat modules, exercises or assignments.
Instructional Design of SOLO-IT
The structure of SOLO-IT provides an online framework where nursing students can
improve competence with commonly used technological tools (Godsey, 2011). Content was
designed to be consistent with the “beginner level” ICs identified by Staggers and colleagues
(2001).
Self-directed learning. The principles of self- directed learning (SDL) were the guiding
framework in the development of SOLO-IT. These principles emphasize the inherent
responsibility of the student to contribute to his or her own learning (Chang, 2006; Fisher et al.,
2001). Self-Directed Learning occurs “proactively, independently, and patiently” (Chang, 2006,
p. 269). Students engaged in SDL are charged with a responsibility to learn, schedule time for
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learning, and plan for integral learning as a means to meet an objective (Chang, 2006). The
concept of individuals who are capable of understanding their own learning needs, goals, and
requirements for learning has been widely studied since its introduction (Knowles, 1975). Self-
directed learning means “learning something proactively, independently, and patiently; being
responsible to learn; learning which is a challenge; a self- training ability and a high curiosity”
(Chang, 2006, p. 269 ). Self-directed learning involves a process by which “learners take
responsibility for planning, carrying out, and evaluating their own learning experiences”
(DeMaris, 2012, p. 42). Self -directed learning requires learners assume an active role as
investors in their own learning (Campbell, Campbell & Dickenson, 1996; Gureckis & Markant,
2012). Self- directed learning encourages students to assume some of the responsibility for their
own learning and views the instructor as facilitator (Hunt, Sproat, & Kitzmiller, 2004). The flow
of information intake is controlled by the learner in a manner that processes information into a
usable form which can be understood and retained (Mikulak, 2012).
Self-directed learners historically perform better in online learning environments (Chou,
2012). In the online environment, SDLs can progress through content at their own pace,
increasing the likelihood for retention of information which might otherwise be lost (Hunt,
Sproat, & Kitzmiller, 2004). Self-directed learning is the most recommended educational model
for competency skill development (Wang & Cranton, 2012).
SOLO’s Web-Based Modules
Each of SOLO-IT’s six modules are embedded within the Blackboard Learning
System™, the most popular distance learning platform used by institutions of higher learning
(Ferriman, 2013). One of the key features of SOLO Informatics Training is the availability of
supplemental tutorials which are easy to identify and select for the struggling new learner.
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Supplemental links lead students to additional demonstrations, screen shots, narrative
descriptions and competency based activities that reinforce content. Hands-on computer
activities occur liberally throughout the course and are structured so that competency
demonstrations are practiced repeatedly, in the absence of submission or time limits. A non-
punitive approach to evaluation is also a feature of SOLO-IT. All quizzes, demonstrations and
written assessments permit unlimited submissions and unlimited time for completion (see
Appendix B for SOLO-IT Course Overview and Grading Criteria; Godsey, 2011). This ‘safe
grading’ environment promotes repeated practice of computer and information literacy skills, in
the absence of time constraints. The foundational intent of SOLO-IT is to be a repository of
easily accessible, digitally based resources where professional students can learn and develop as
competent informatics users. Students remain enrolled in SOLO-IT during the duration of their
MSN Program progression, and may access or repeat training modules, as often as desired.
SOLO-IT consists of the following six modules:
• Module I: Introduction to SOLO-IT: Introduces nursing students to the features of SOLO-IT
and the Blackboard platform. The objectives for this module include:
1. Demonstrate the ability to navigate Blackboard
2. Describe the purpose of the Successful Online Learning Orientation (SOLO-IT) course
3. Perform a browser and software check to enable the necessary functions for successful
course completion
• Module II- Navigating the Computer and Web: Introduces nursing students to the parts and
functions of the computer and presents practice exercises for browsing the web. The
objectives for this module include:
1. Describe the parts and functions of a personal computer
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2. Explore the use of the internet as a tool to inform nursing practice
3. Demonstrate the ability to use and manage an email account
4. Demonstrate understanding of the importance of anti-virus protection
5. Demonstrate the ability to back up computer files
• Module III- Computer Applications: Presents computer applications commonly used by
nurses, including spreadsheets, documents, and presentation software. The objectives for this
module include:
1. Apply the document construction principles of Microsoft Word, Excel, and Power Point
2. Demonstrate the ability to save and edit documents
3. Demonstrate the ability to create a folder for document organization
4. Demonstrate the ability to create and use Excel spreadsheets
5. Create a PowerPoint slide presentation
• Module IV- Information Literacy: Presents library and web based research tools that support
information literacy and Evidence Based Practice. The objectives for this module include:
1. Explain the nursing research process
2. Demonstrate effective use of search engines, such as Google Scholar
3. Locate scholarly articles and journals that support nursing research and Evidence Based
Practice
4. Demonstrate the process for locating and evaluating scholarly articles and websites
5. Discuss safeguards that should be applied when using social media
• Module V- Preparation for Research: Presents an overview of professional writing and
publication principles. The objectives for this module include:
1. Describe plagiarism avoidance and copyright issues
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2. Demonstrate the principles of scholarly writing using American Psychological
Association (APA) format
• Module VI-Issues for the Professional e-Nurse: Introduces future e-nurses to professional
issues encountered in the clinical setting. The objectives for this module include:
1. Explore the role of nursing informatics in health care
2. Describe how Information Technology (IT) is transforming healthcare
3. Describe upcoming changes to healthcare due to the American Recovery and
Reinvestment Act (ARRA) and the Accountable Care Act (ACA)
4. Describe the roles and responsibilities of nursing in the area of health IT and Personal
Health Information (PHI).
5. Explain the difference between the electronic health record (EHR) and the electronic
medical record (EMR).
6. Outline opportunities for nursing in today’s technology rich healthcare environment
(Godsey, 2011)
Each SOLO-IT module requires various demonstrations of computer competency and
information literacy. The following list outlines the competencies which students must
demonstrate to successfully complete SOLO-IT:
• Understand the term hardware
• Understand the main components and functions of a personal computer
• Know the main parts of a computer
• Know the main types of storage media
• Identify the main input devices
• Know the main output devices
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• Understand the term software
• Understand the principles of an operating system
• Identify and know the uses of common software
• Understand what the internet is and know its main uses
• Understand the concepts of downloading and uploading
• Understand the term electronic mail
• Understand the importance of having backup copy of files
• Know ways to prevent data theft
• Understand the term computer virus
• Know how to protect against viruses
• Understand the term copyright
• Know how to store files
• Identify common file types: word processing, spreadsheet, database
• Name files/folders
• Copy files
• Open, close a word processing application
• Create a new document
• Save a document to a location on a drive
• Created a PowerPoint containing a background and at least one graphic (or whatever the
assignment was).
• Saved and attached documents
• Understand what the World Wide Web (www) is
• Explain the function of a web browser
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• Understand and use a search engine
• Know how to identify a secure web site
• Open, close a web browsing application
• Enter a URL in the address bar and go to the URL
• Navigate to the home page
• Select a specific search engine
• Copy, text, image URL from a web page to a document
• Preview a web page
• Understand the term email and know its main use
• Understand the make-up and structure of an email address
• Understand the importance of network etiquette
• Understand the difference between To, CC, BCC fields
• Open, close an email application
• Create a new email
• Enter an email address into the To, CC, BCC fields
• Enter a title in the subject field
• Send an email
• Use the reply, reply to all function
• Forward an email
• Delete an email
• Access needed information effectively and efficiently
• Use information effectively to accomplish a specific goal (Godsey, 2011).
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Plan for Data Collection and Analyses
Process to Determine Study Feasibility
This study required access to a significant population of nursing students and use of the
university’s proprietary LMS, Blackboard. As such, a process was initiated during the 2012-13
academic school year to determine the feasibility of conducting dissertation research exploring
the role of SOLO-IT as an intervention to improve the informatics competencies of nursing
students. The process of determining feasibility is outlined below:
1. Permission was granted by the Director of the School of Nursing and the Nursing Faculty
Organization (NFO) to conduct future dissertation research using a population of entry level
undergraduate nursing students in the School of Nursing.
2. Permission was requested and obtained from the university’s Distance Learning Department
to use the Blackboard platform to house and deliver SOLO-IT modules.
3. Curricular policies were developed outlining the process for students to follow to
successfully complete SOLO-IT. This policy was collaboratively designed and
unanimously approved by the Nursing Faculty Organization. The policy included suggested
syllabus wording regarding the completion of SOLO-IT as a required assignment in certain
entry level courses.
4. Nursing faculty granted permission for the PI of this study to be enrolled (as a Teaching
Assistant) into the Blackboard sections of each designated course.
5. Completion of SOLO-IT will be required as a course assignment and will be worth 10% of
the course grade.
6. A Completion Certificate was awarded for all students who successfully completed SOLO-
IT with a grade of a 92% or higher. SOLO-IT has a maximum of 100 points possible and is
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worth 10% of the total course grade for select courses. The faculty determined that skills
obtained (or strengthened) through SOLO-IT are critically important and students would be
more likely to take the course seriously if assignment credit was associated with completion
of training.
Following more than one year of planning, it was concluded that dissertation research
involving a comprehensive educational intervention with a sample of approximately 270
nursing students and the use of proprietary LMS software was feasible at this university.
Unanimous approval by faculty of the School of Nursing, permission from the Director of the
School of Nursing and the Educational Technology Department, and the preliminary approval
of the sponsoring university’s IRB have been successfully obtained to conduct dissertation
research. Approval from the University of Hawaii’s IRB has been obtained to extract and
analyze archived survey data as a means of analyzing the psychometric properties and
performance of the SANICS instrument.
Data Analysis Plan
This research study will use principal factor analysis to examine the structure and internal
consistency reliability of the SANICS to examine the psychometric properties of the SANICS
among a sample of BSN entry-level nursing students, and to determine if the SANICS is
responsive over time when used to measure informatics competencies before and after
implementation of SOLO-IT modules. Construct validity of the SANICS will be assessed using
a known group approach to compare differences in means for each SANICS subscale (construct)
before and after completion of Successful Online Learning and Orientation Informatics Training
(SOLO-IT) modules. Means, standard deviations, and sample sizes will be computed for items
within each SANICS sub-scale category to test the hypothesis that differences in scores from
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pre- to post- survey (using archived data) will be significant following completion of SOLO-IT
training. Significant results, small p-values, and differences from pre-survey to post-survey in
amounts greater than zero may indicate that SOLO-IT training had a positive effect on students’
self-perceptions of IC. Significant results with a negative difference will indicate that an adverse
effect resulted from completion of SOLO-IT training.
Acquisition of informatics skills was the primary purpose of SOLO-IT. Repeated
attempts on assignments or demonstration exercises were encouraged and resulted in an
unusually high overall course average of 94%. Because all students were required to successful
complete SOLO-IT, the resulting final scores were high and did not provide the data spread
necessary to correlate demonstrated competency scores within SOLO-IT with self -reported
competencies on the SANICS. Plans are underway to re-design the assessment portion of the
course so that correlations between perceived versus demonstrated competencies can be made.
Statistical Power. This study will use a sample size of almost 500 nursing students (256
pre and 242 post SOLO-IT). Recommendations for sample size in factor analysis vary widely in
the literature. Traditional recommendations have included 10 respondents per item (Sapnas &
Zeller, 2002). However, “hypothetical and real research examples illustrate the usefulness of
sub-sample analysis in determining that a sample size of at least 50 and not more than 100
subjects is adequate to represent and evaluate the psychometric properties of measures of social
constructs” (Sapnas & Zeller, 2002, p. 135).
A power analysis using the G power program (Faul & Erdfelder, 2007) was performed to
determine the sample size required for a t-test comparison of means at alpha= 0.05. The result of
this analysis indicated a total sample size of 202 participants (101 for each group) would be
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necessary to obtain a medium effect size (d=0.5) and 95% power (Faul & Erdfelder, 2007;
Appendix C).
Plan for Statistical Analysis. Survey Monkey™ was the software program used to
administer anonymous surveys using a 1-5 Likert Scale. Course evaluation procedures were also
conducted and included user satisfaction items ranked on a 1-5 Likert Scale, and open-ended
questions using text boxes to facilitate narrative comments.
A SPSS 21 Grad Pack will be used for all psychometric analyses. Principal component
analysis will be used to “extract the maximum variance from the data set, resulting in a few
orthogonal (uncorrelated) components” (2010, p. 234). A parallel analysis will be performed
using a simulator with the same number of variables and observations. Factor loadings and
promax rotation with Kaiser normalization will be used to examine and confirm correlations
among factors (Tabachnick & Fidell, 2007). The performance of the SANICS and the five
categorical factors of the scale will be assessed using Cronbach’s alpha (Tabachnick & Fidell,
2007). A standardized response mean will be used to evaluate the responsiveness of the
SANICS over time (Neale & Liebert, 1986). Differences between pre- and post- survey scores
will be analyzed using two sample t-tests at p = 0.05. The factor structure and internal
consistency reliability of the SANICS will be compared with the study conducted by the authors
of the SANICS instrument (Yoon, Yen & Bakken, 2009) to determine if the instrument’s
psychometric properties remained consistent when used in a sample of BSN entry level students
following informatics training.
Ethical Considerations
University of Hawaii Institutional Review Board (IRB). Approval has been granted
by the University of Hawaii’s IRB to conduct a psychometric analysis of archived SANICS data
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(Appendix D). The request was made for exempt review since the study will involve no risk to
former study participants who completed SOLO-IT and participated in pre/post SANICS data
collection procedures. All data were collected in accordance with study procedures, as approved
by the sponsoring agency (Xavier University) at the time the SOLO-IT course was implemented.
All SANICS pre- and post-survey data were collected anonymously on an off-site third party
secure server. The software (Survey Monkey) has a decoding feature which provides the
following security functions: Firewall restricts access; intrusion detection systems and other
systems that detect and prevent interference or access from outside intruders; QualysGuard
network security audits performed weekly; McAfee SECURE scans performed daily; all data is
stored on servers located in the United States; backups occur hourly internally, and daily to a
centralized backup system for offsite storage; backups are encrypted (Survey Monkey, 2013).
Since the time of data collection, all study results have been stored securely within Survey
Monkey as anonymous, aggregate data.
Upon secure log on to SOLO-IT modules, students were routed to an announcements
page where they were introduced to the modules and provided a link to the pre-course survey.
Students were informed: 1) participation in the pre/post survey portion of the course was
completely voluntary, 2) identities would remain anonymous, 3) no effort would be made to
match survey responses with identifiers in Blackboard, and 4) survey data would be collected
and stored anonymously on Survey Monkey (secure, off-site, encrypted, survey software).
Students were also advised that any survey response (or lack of response) would have no impact
on assignment or course grade. Students were also informed that aggregate evaluative data
would facilitate course evaluation strategies and support quality improvement measures.
78
Xavier University IRB. To ensure compliance with university level policies and
procedures and to determine the level of cooperation by the university’s Institutional Review
Board (IRB), a SOLO-IT research proposal was submitted requesting advanced permission to
conduct future PhD student research using a population of nursing students attending the
sponsoring university. The preliminary request for IRB approval was made to determine the
feasibility of performing future research at the sponsoring institution in partial fulfillment of the
dissertation requirements leading to a PhD in Nursing from the University of Hawaii for the
study’s Principle Investigator (PI). Study approval was granted by the sponsoring university’s
IRB and included an open ended date for collection and analyses of study data (Appendix E).
Informed consent was obtained from each student participant. Students were advised of
study procedures and the voluntary nature of survey completion, as evidenced by: 1) the option
to click the link to gain voluntary access to the survey, 2) the option to voluntarily complete pre-
and post- surveys, and 3) the anonymous nature of the survey via an off-site secure server.
Nursing faculty of select entry level courses volunteered to include SOLO-IT completion
as one of the required assignments leading to partial fulfillment of one or more course objectives
(see Appendix C for Course Overview and Grading Criteria; Godsey, 2011). Completion of the
SOLO-IT modules was required for select entry level courses. However, completion of all
SOLO-IT related pre- and post- competency surveys was strictly voluntary.
During the first week of the semester, students enrolled into the SOLO-IT course
received an introductory e-mail message from the PI and SOLO-IT instructional designer
describing the training modules and outlining access to SOLO-IT training. To measure
perceptions of IC, students were asked to complete voluntary surveys prior to and immediately
following completion of SOLO-IT. Student volunteers were informed that data resulting from
79
completion of surveys would inform this research study and would support quality initiatives
within the nursing program. Instructions accompanying pre- and post-surveys restated and
emphasized the voluntary and anonymous nature of study participation. Students were also
advised that survey responses would be analyzed as aggregate data and no attempt would be
made to match enrollment data resulting from SOLO-IT training with anonymous survey data.
Additionally, students were informed that, while completion of SOLO-IT training is a course
requirement, lack of participation in voluntary survey procedures or quality of survey response
would have no impact on assignment or course grades. Finally, students were advised that
survey data would be collected via an off-site, secure server with encryption features. Refusal to
participate in the data collection procedures associated with SOLO-IT survey completion would
not be tracked in any way, further providing assurance that penalties could not be incurred for
lack of survey participation.
Limitations of the Design
A sample of undergraduate nursing students were pre-tested on the dependent variable
(informatics competencies) then post-tested following completion of SOLO-IT. This design is
considered superior to a post-test only design because it allows for the effect of the intervention
to be measured as the difference between pre-post scores. However, a one-group pre/post-test
design does not control for potentially confounding variables, such as history, maturation or
regression artifact (Johnson & Christensen, 2004). This study was taken from one sample of
undergraduate nursing students from a single private university in the mid-west, which could
limit generalizability of findings to other populations (eg. graduate students) or sites.
Additionally, measurements of computer competency were based on self-perceptions which may
not accurately represent ability to demonstrate competency. Finally, the possibility for a conflict
80
of interest exists given the intervention for this study (SOLO-IT) was also designed and
implemented by the researcher. Full disclosure of this association will be made in all forms of
reporting and in the dissemination of research findings.
Summary
The components of this study included a thorough literature review describing computer
competency, information literacy skills, and the current state of informatics competency among
the nursing profession. A comprehensive search of informatics training resources revealed a
significant gap in the literature regarding the availability of valid and reliable informatics
training resources and valid, reliable tools to measure informatics competencies. The SOLO-IT
program is an online educational intervention designed to improve the informatics competencies
of nursing students. A one-group pre/post-test design using the SANICS was utilized in a
sample of undergraduate nursing students. Surveys comprised of competency items were
administered via Survey Monkey to student volunteers prior to and at the completion of SOLO-
IT.
This study will explore the psychometric performance of the SANICS. Archived pre/post
SOLO-IT data will be used to assess the factor structure and internal consistency reliability of
the SANICS, and to examine the psychometric properties of the SANICS among a sample of
BSN entry-level nursing students, and to determine if the SANICS is responsive over time when
used to measure informatics competencies following completion of SOLO-IT. This study will
also evaluate the mean rating differences of SANICS scores before and after completion of
SOLO-IT. Construct validity of the SANICS will be assessed using a known group approach to
compare differences in means for each SANICS subscale (construct) before and after completion
of Successful Online Learning and Orientation Informatics Training (SOLO-IT) modules.
81
Chapter IV
Results
This chapter provides descriptions of the study sample and presents the factor structure,
internal consistency reliability and responsiveness of the SANICS instrument. Findings reported
in this chapter will serve to answer the following research questions:
What are the psychometric properties of the SANICS among a population of BSN entry-level
students?
Is the SANICS responsive over time when used to measure informatics competencies
following completion of SOLO-IT?
Research Design
This study explored the psychometric performance of the SANICS instrument using
archived survey data collected before and after completion of SOLO-IT. A pre/post-test design
using the 30-item SANICS was utilized in a sample of undergraduate nursing students. Surveys
comprised of competency items contained within the SANICS instrument were administered via
Survey Monkey to student volunteers prior to and at the completion of SOLO-IT.
Setting and Sample
During the period of January-March, 2014, two hundred seventy one (271) entry level
BSN students from a medium sized mid-western university were enrolled into SOLO-IT. A total
of 229 students (85%) successfully completed all SOLO-IT assignments, requiring an average of
two attempts per assignment in order to achieve the minimum passing score of 92% (overall
course average was 97%). Forty two students started, but did not complete all assignments in
SOLO-IT (although 13 of these students still chose to complete the post-training SANICS
survey). Most, but not all, course instructors required SOLO-IT completion. Courses which
82
lacked the formal requirement of SOLO-IT completion likely negatively influenced some of the
students’ decision not to complete the training.
Of the 271 students originally enrolled in SOLO-IT, 256 completed the pre-course
SANICS survey data (response rate of 94.4%) and 242 completed the post-training SANICS
survey (response rate of 89.2%), for a total sample size of 498 BSN students (see Figure 2).
Both the pre- and post- training surveys were administered using Survey Monkey software. All
data were entered and analyzed using Microsoft Excel and SPSS version 18.0 statistical
software.
Figure 2
SOLO-IT and SANICS: Participation and Return Rates
83
Profile of Respondents
The sample for this study was 89.5% female and 10.5% male. Most of the student
volunteers were 20-29 (58.4%), followed by 30-39 (25.3%). Students in the combined 40-64 age
group made up 16.4% of the study population (12.1% in the 40-49 age group and 4.3% in the 50-
64 age group) (see Table 3).
Almost all of the BSN students in this study used computers for more than two years
(97.7%). Six students (2.3%) reported using computers for less than six months. The majority
of students reported using computers several times a day or daily (94.2%), followed by several
times a week (5.1%). Two students (0.8%) reported using computers only several times a
month, or never (see Table 3).
Table 3
BSN Demographics
Variable Count Percent
Gender
Female 230 89.5%
Male 27 10.5%
Total 257 100.0%
Age
20-29 150 58.4%
30-39 65 25.3%
40-49 31 12.1%
50-64 11 4.3%
Total 257 100.0%
Computer Experience
Just started using in the past 6 months 6 2.3%
In the past 2 years 0 0%
More than 2 years 251 97.7%
Total 257 100.0%
84
Presentation of Data for Research Question One
The first research question addressed by this study is “what are the psychometric
properties of the SANICS among a population of BSN entry-level students”? In response to this
question, the following discussion outlines the factor structure, internal consistency reliability,
and responsiveness of the SANICS instrument.
Principal Component Analysis
Principal component analysis was performed to determine the factor structure of the 30-
item SANICS (Table 4). Promax rotation with Kaiser Normalization was used to examine
correlations among five factors: Basic Computer Knowledge And Skills; Clinical Informatics
Role; Applied Computer Skills; Clinical Informatics Attitudes; And Wireless Device Skills.
Almost all (27 of 30) factor loadings increased over pre-SOLO-IT. Five factors accounted for
71.6% of the variance in the 30 item scale (pre-SOLO-IT) and the percentage of variation
increased to 77.3% post SOLO-IT.
Frequency of Computer Use
Several times a day 195 76.2%
Once a day 46 18.0%
Several times a week 13 5.1%
Several times a month 1 0.4%
Never 1 0.4%
Total 256 100.0%
85
Table 4
Factor Structure Matrix Pre-and Post-SOLO-IT
Structure Matrix (Pre-SOLO-IT) Structure Matrix (Post-SOLO-IT)
Component
Component
1 2 3 4 5 1 2 3 4 5 G1_Q1 .188 .824 .580 .403 .370 G1_Q1 .472 .908 .667 .386 .403
G1_Q2 .360 .869 .515 .375 .464 G1_Q2 .509 .920 .638 .497 .446
G1_Q3 .256 .867 .427 .431 .420 G1_Q3 .464 .915 .557 .489 .282
G1_Q4 .381 .847 .402 .334 .419 G1_Q4 .547 .909 .587 .533 .361
G1_Q5 .356 .888 .515 .335 .444 G1_Q5 .502 .941 .624 .485 .383
G2_Q1 .599 .373 .317 .229 .695 G2_Q1 .772 .502 .497 .429 .683
G2_Q2 .595 .383 .309 .483 .756 G2_Q2 .858 .448 .351 .572 .478
G2_Q3 .632 .607 .542 .111 .506 G2_Q3 .742 .548 .697 .437 .240
G2_Q4 .714 .565 .453 .218 .587 G2_Q4 .854 .476 .630 .470 .396
G2_Q5 .692 .449 .255 .443 .703 G2_Q5 .864 .488 .588 .578 .448
G2_Q6 .813 .186 .283 .174 .509 G2_Q6 .851 .401 .369 .521 .463
G2_Q7 .840 .195 .315 .176 .543 G2_Q7 .864 .418 .428 .573 .474
G2_Q8 .627 .233 .257 .376 .750 G2_Q8 .857 .359 .357 .557 .456
G2_Q9 .776 .465 .395 .301 .705 G2_Q9 .856 .475 .494 .500 .395
G2_Q10 .863 .376 .421 .259 .612 G2_Q10 .839 .521 .632 .571 .552
G2_Q11 .799 .423 .432 .281 .551 G2_Q11 .783 .511 .701 .473 .553
G2_Q12 .531 .309 .315 .369 .816 G2_Q12 .889 .493 .515 .619 .561
G2_Q13 .597 .437 .366 .443 .769 G2_Q13 .867 .429 .428 .594 .579
G2_Q14 .582 .430 .446 .425 .776 G2_Q14 .834 .406 .499 .531 .655
G2_Q15 .635 .495 .499 .407 .794 G2_Q15 .822 .463 .590 .436 .630
G3_Q1 .355 .517 .897 .252 .398 G3_Q1 .445 .634 .893 .402 .450
G3_Q2 .416 .543 .919 .268 .415 G3_Q2 .493 .677 .915 .455 .459
G3_Q3 .476 .481 .881 .308 .502 G3_Q3 .549 .592 .925 .507 .480
G3_Q4 .447 .547 .904 .341 .475 G3_Q4 .532 .579 .922 .515 .493
G4_Q1 .265 .405 .323 .920 .453 G4_Q1 .632 .506 .496 .932 .394
G4_Q2 .258 .431 .314 .922 .539 G4_Q2 .645 .515 .542 .944 .520
G4_Q3 .312 .411 .293 .924 .520 G4_Q3 .643 .508 .501 .955 .500
G4_Q4 .264 .427 .307 .926 .492 G4_Q4 .642 .589 .548 .940 .510
G5_Q1 .470 .505 .433 .455 .824 G5_Q1 .700 .486 .612 .554 .903
G5_Q2 .493 .477 .415 .430 .837 G5_Q2 .687 .483 .591 .559 .901
86
Parallel Analysis
Parallel analysis was conducted to determine which factors to retain. This simulation
method compared observed eigenvalues with eigenvalues from a random sample consisting of
the same number of variables and observations. All scores were over 0.50 on the primary
loading of items after rotation, which was the cut off for retention of items. Observed and
simulated eigenvalues intersected at the five factor level, further validating the five factors of the
SANICS (see Figure 3).
Figure 3
Parallel Analysis
Psychometric Analysis: Comparisons with Original SANICS Study
Construct validity refers to an instrument’s ability to measure constructs adequately
(Shuttleworth, 2014). The presence of statistically significant differences between pre and post-
SOLO-IT suggest the construct validity of the SANICS is good. Effect size of the thirty items
showed a medium to large effect.
0123456789
1011121314
0 5 10 15 20 25 30
Simulated Eigenvalues OBS Eigenvalue
87
Internal consistency reliability was determined using Cronbach’s α for each of the five
sub-scales: Applied Computer Skills, Clinical Informatics Role, Wireless Device Skills, Basic
Computer Knowledge and Skills, and Clinical Informatics Attitudes.
Comparisons of factor loadings and Cronbach’s α were made between: 1) pre/post
SOLO-IT and 2) those reported by Yoon and colleagues (2009) (see Table 5). Cronbach’s α was
higher post-SOLO-IT (.95-.97) compared to pre-SOLO-IT (.92-.95), and compared to the
original SANICS study (.89-.94) for each of the five sub-scales of the instrument. These alphas
would be considered in the excellent range (Nunnally & Bernstein, 1994). Almost half (14 of
30) of the factor loadings were .90 or greater following SOLO-IT completion, compared to 23%
(7 of 30) pre-SOLO-IT.
Table 5
Factor Structure Compared to Original SANICS Study
Yoon
SANICS
(BS/MS)
Pre-SOLO-IT
SANICS
(BSN)
Post-SOLO-IT
SANICS
(BSN)
Clinical Informatics Role (5 items)
α = .91,
n = 328,
M (SD) =
2.62 (.91)
α = .92,
n = 251,
M (SD) =
2.65 (1.29)
α = .96,
n = 240,
M (SD) =
3.52 (.96)
As a clinician (nurse), participate in the
selection process, design, implementation and
evaluation of systems.
.83 .82 .91
Market self, system, or application to others .82 .87 .92
Promote the integrity of and access to
information to include but not limited to
confidentiality, legal, ethical, and security
issues
.82 .87 .92
Seek resources to help formulate ethical
decisions in computing
.83 .85 .91
Act as advocate of leaders for incorporating
innovations and informatics concepts into
their area of specialty
.83 .89 .94
88
Basic Computer Knowledge and Skills
(15 items)
α = .94,
n = 321,
M (SD) =
3.86 (.71)
α = .94,
n = 247,
M (SD) =
3.66 (1.15)
α = .97,
n = 238,
M (SD) =
4.10 (.82)
Use telecommunication devices .73 .60 .77
Use the Internet to locate, download items of
interest
.70
.60
.86
Use database management program to develop
a simple database
.68 .63 .74
Use database applications to enter and retrieve
information
.81 .71 .85
Conduct on-line literature searches .74 .69 .86
Use presentation graphics to create slides,
displays
.74 .81 .85
Use multimedia presentations .74 .84 .86
Use word processing .72 .63 .86
Use networks to navigate systems .75 .78 .86
Use operating systems .74 .86 .84
Use existing external peripheral devices .79 .80 .78
Use computer technology safely .80 .53 .89
Navigate Windows .77 .60 .87
Identify the basic components of the computer
system
.77 .58 .83
Perform basic trouble-shooting in applications .81 .64 .82
Applied Computer Skills: Clinical
Informatics (4 items)
α = .89,
n = 330,
M (SD) =
2.45 (1.03)
α = .93,
n = 255,
M (SD) =
2.25 (1.36)
α = .95,
n = 240,
M (SD) =
3.24 (1.07)
Use applications for diagnostic coding .71 .90 .89
Use applications to develop testing materials .69 .92 .92
Access shared data sets .75 .88 .93
Extract data from clinical data sets .77 .90 .92
Clinical Informatics Attitudes
(4 items)
α = .94,
n = 332,
M(SD) =
3.74 (.97)
α = .95,
n = 255,
M(SD) =
3.82 (1.14)
α = .97,
n = 242,
M(SD) =
4.15 (.85)
Recognize that health computing will become
more common
.82 .92 .93
Recognize human functions that cannot be
performed by computer
.83 .92 .94
Recognize that one does not have to be a
computer programmer to make effective use
of the computer in nursing
.83 .92 .96
Recognize the value of clinician involvement
in the design, selection, implementation, and
evaluation of applications, systems in health
care
.78 .93 .94
Wireless Device Skills (2 items)
α = .90,
n = 328,
M(SD) =
2.75 (1.16)
α = .95,
n = 255,
M(SD) =
3.44 (1.25)
α = .96,
n = 242,
M(SD) =
4.07 (.84)
Use wireless device to download safety and
quality care resources
.77 .82 .90
Use wireless device to enter data .76 .84 .90
89
Presentation of Data for Research Question Two
The following discussion answers the next question posed by this research: Is the
SANICS responsive over time when used to measure informatics competencies following
completion of SOLO-IT? Study participants were asked to rate perceived informatics
competencies for each of 30 SANICS items using a five-point Likert Scale, from one (strongly
disagree) to five (strongly agree). Two sample t-tests were used to determine means, standard
deviation, and sample sizes for each SANICS sub-scale category (Clinical Informatics Role,
Basic Computer Knowledge and Skills, Applied Composite Skills, Clinical Informatics
Attitudes, and Wireless Device Skills). It was not possible to pair sample data due to the
unplanned loss of an item on the post-survey (during a Blackboard upgrade) which requested the
respondent’s student identification number. Responsiveness of the SANICS was examined to
test the hypothesis that there would be a significant difference in SANICS scores between pre-
SOLO-IT and post-SOLO-IT.
All mean differences were significantly higher on each of the five SANICS sub-scale
categories following completion of SOLO-IT (p < 0.001). Differences from pre-score to post-
score are listed below from greatest to least amount of difference and are further delineated on
Table 6:
1. Applied Computer Skills (+2.02)
2. Clinical Informatics Role (+.87)
3. Wireless Device Skills (+.63)
4. Basic Computer Knowledge and Skills (+.44)
5. Clinical Informatics Attitudes, (+0.33).
90
Interestingly, differences in mean SANICS scores pre- to post-SOLO-IT were greatest in two
sub-scale categories not specifically covered by SOLO-IT’s introductory content (“Applied
Computer Skills” and “Clinical Informatics Role”). An explanation for this finding could relate
to the advanced wording of some of the competencies listed under this item, and will be further
discussed in the “Limitations” section of Chapter Five.
Table 6
Average Scores for Each SANICS Sub-Scale Pre/Post SOLO-IT
Mean SANICS scores following SOLO-IT completion were then compared with scores
from the original SANICS study conducted by Yoon, et al. (2009) in a population of BS/MS
students taking an informatics course. The population for this study consisted of all students
participating in a curriculum which emphasized informatics tools for patient safety, modeling,
and monitoring. The curriculum included didactic lectures on informatics for patient safety and
web-based reporting of hazards and near misses. Significantly higher mean SANICS scores
Pre-SOLO-IT
SANICS
n= 256
Post-SOLO-IT
SANICS
n= 242
Pre-SOLO-IT SANICS
-vs-
Post-SOLO-IT SANICS
Mean SD Mean SD P-value Conclusion
Basic Computer
Knowledge and Skills 3.66 1.07 4.10 0.81 P < .001
Post-SOLO-IT
is higher
Applied Computer Skills 1.87 1.10 3.89 0.87 P < .001
Post-SOLO-IT
is higher
Clinical Informatics Role 2.65 1.27 3.52 0.97 P < .001
Post-SOLO-IT
is higher
Clinical Informatics
Attitude 3.82 1.14 4.15 0.85 P < .001
Post-SOLO-IT
is higher
Wireless Device Skills 3.44 1.25 4.07 0.84 P < .001
Post-SOLO-IT
is higher
91
were reported post-SOLO-IT on all five sub-scales compared to the mean SANICS scores
reported on the original SANICS study (p < 0.001) (see Table 7).
Table 7
SANICS Scores Post-SOLO-IT Compared to Original SANICS Study
Value of SOLO-IT
Post-training SANICS surveys were identical to pre-training SANICS surveys, except for
the addition of 10 optional Likert scale items rating the overall effectiveness of SOLO-IT. At the
completion of the final assignment in SOLO-IT, students were asked to rate the value of the
training on a 1-5 Likert scale. Composite rating of all items was 4.0. Scores were highest on the
items “I found instructions in SOLO-IT clear and easy to understand” (4.1), “SOLO-IT provided
information in a manner that was easy to comprehend” (4.1), and “I feel confident I could now
Yoon SANICS
n=332 (BS/MS)
Post-SOLO-IT
SANICS
N=242 (BSN)
Post-SOLO-IT SANICS
-vs-
Yoon SANICS
Mean SD Mean SD P-value Conclusion
Basic Computer
Knowledge and Skills 3.86 0.71 4.10 0.81 p<.001
Post-SOLO-IT
is higher
Applied Computer
Skills 2.45 1.03 3.89 0.87 p<.001
Post-SOLO-IT
is higher
Clinical Informatics
Role 2.62 0.91 3.52 0.97 p<.001
Post-SOLO-IT
is higher
Clinical Informatics
Attitude 3.74 0.97 4.15 0.85 p<.001
Post-SOLO-IT
is higher
Wireless Device Skills 2.75 1.16 4.07 0.84 p<.001
Post-SOLO-IT
is higher
92
use Blackboard” (4.2). Scores were lowest on the items “using SOLO-IT was appropriate for my
learning as a nursing student” (3.8), and “I would recommend SOLO-IT to other students” (3.6)
(see Table 8).
Table 8
Value of SOLO-IT
Value of SOLO-IT N Mean SD
Using the SOLO-IT course was appropriate for my
learning as a nursing student. 241 3.8 0.88
I found the SOLO-IT site easy to use and follow. 241 4.0 0.82
I found instructions in SOLO-IT clear and easy to
understand. 240 4.1 0.78
The layout and design of SOLO-IT was user friendly. 241 4.0 0.79
SOLO-IT provided information I need. 239 4.0 0.80
I felt comfortable doing assignments in SOLO-IT 242 4.0 0.80
SOLO-IT provided information that will prepare me for
success as a student. 241 4.0 0.78
SOLO-IT provided information in a manner that was
easy to comprehend. 242 4.1 0.67
I feel confident that I could now use the online learning
course site, Blackboard 241 4.2 0.67
I would recommend SOLO-IT to other students 241 3.6 1.02
Composite 4.0
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Summary
This chapter presented the factor structure, internal consistency reliability, and
responsiveness of the SANICS instrument before and after SOLO-IT training, and compared
those findings with the original SANICS research conducted by Yoon and colleagues (2009).
Evidence was presented which supports the reliability and validity of the SANICS as a tool to
measure perceptions of informatics competencies before and after a self-directed, online,
informatics training intervention. The next chapter will discuss implications of these findings for
the nursing profession.
94
Chapter V
Discussion
The previous chapter presented findings from this study. This chapter will include a
discussion of those findings, their implications for nursing practice, and recommendations for
future studies. Limitations of this study will also be described.
Sample Size and Return Rates
This study used a sample of 498 nursing students tested on the 30 item SANICS before
(n=256) and after (n=242) completion of SOLO-IT. The number of participants in this study
exceeded the minimum of 100 subjects recommended to evaluate psychometric properties of an
instrument (Sapnas & Zeller, 2002). Response rates for both pre- and post-SOLO-IT were high
at 94.4% and 89.2%, respectfully.
Study Participants
As is typical for an undergraduate nursing program, the majority of students were female
(89.5%) and between the ages of 20-39 (83.7%). Most students reported frequent use of
computers, with 94.2% reporting use several times a day for more than two years. The younger
age of participants and the frequency of computer usage suggest that most students were exposed
to computers during or prior to secondary school. However, despite the self-described
familiarity with computers, this younger group of nursing students still reported significant
increases in perceived competencies for each SANICS sub-scale following completion of SOLO-
IT. This finding is described in more detail in the discussion to follow.
Research Question #1
What are the psychometric properties of the SANICS among a population of BSN entry-level
students?
95
The psychometric properties of the SANICS have been well described by Yoon and
colleagues (2009) with their combined sample of 337 BSN/MSN students. Reliability and
validity of the instrument was evident with their sample. Findings from this study also support
the SANICS as a psychometrically sound instrument when used before and after informatics
training in a population of undergraduate nursing students. Principle component analysis
supported the five factor structure of the SANICS, and was consistent with findings from the
original study. Reliability of the instrument was high and percent of variation for almost all
factors increased from pre- to post, as well as loadings within factors. Parallel analysis showed
all scores to be > .50 after rotation, and simulated eigenvalues validated the five factors of the
scale.
Cronbach’s α measurements confirmed the internal consistency of related items within
the 93 item scale. Cronbach’s α was in the excellent range (.95-.97) following SOLO-IT when
compared with pre-training and original SANICS scores. None of the inter-item correlations was
less than α = .89. Reliability coefficients of .70 or higher are usually considered acceptable by
most researchers (Bruin, 2006).
Research Question #2
Is the SANICS responsive over time when used to measure informatics competencies
following completion of SOLO-IT?
The independent two sample t-test is “the most basic statistical test that measures group
differences…[and] analyzes significant differences between two group means” (Mertler &
Vannatta, 2010, p. 14). Independent t-tests confirmed the responsiveness of the SANICS over
time and also measured the five categorical factors of the scale: 1) Clinical Role, 2) Basic
Computer Knowledge, 3) Applied Computer Skills, 4) Clinical Informatics Attitudes, and 5)
96
Wireless Device Skills. Significantly higher mean scores following SOLO-IT were reported on
each of the five SANICS’ five sub-scales, compared to pre-SOLO-IT (p < 0.001) and, when
compared to the original SANICS study (p < 0.001). This finding further supports the
responsiveness of the SANICS over time, when used to measure perceived informatics
competencies of nursing students. Each SANICS sub-scale score increased following SOLO-IT
(from a low of 1.87 pre-training to 3.89 post-training for the “Applied Computer Skills”
category, to the highest sub-scale scores for the “Basic Computer Knowledge and Skills”
category, which went from 3.66 pre-to 4.10 post-training). A competency score of 3.0 or greater
would be consistent with “perceived competence” (Yoon, et. al, 2009).
Differences from pre-score to post- score were greatest in the sub-scale categories
“Applied Computer Skills” (+2.02) and “Clinical Informatics Role” (+.87). These sub-scales
contained items, such as “use applications for diagnostic coding”, “extract data from clinical data
sets”, “act as advocate of leaders for incorporating innovations and informatics concepts into
their area of specialty”. Such a large increase from pre- to post-training suggests SOLO-IT may
have effectively introduced more advanced practice application concepts to entry level nursing
students who would not be expected to have experience or familiarity with these principles. The
areas with the least change from pre- to post- SOLO-IT were “ Basic Computer Knowledge and
Skills” and “Wireless Device Skills”, as might be expected in a younger population of nursing
students already accustomed to using computers and wireless devices.
Value of SOLO-IT
Post-training items to evaluate program effectiveness indicate that students valued the
online presentation and content offered by SOLO-IT. Composite score for all items was 4.0,
with the highest score reported for the item “I feel confident I could now use the online learning
97
course site, Blackboard” (4.2). Program evaluation scores further support the potential value of
online informatics training as a tool to prepare and familiarize students with the educational
technologies used during nursing program matriculation.
Limitations
The sample population for this study was confined to one academic institution in the mid-
west which may limit generalizability to other settings. A one-group pre/post-test design does
not control for potentially confounding variables, such as history, maturation or regression
artifact (Johnson & Christensen, 2004).
Lack of randomization and the requirement (rather than the option) for entry level
students to complete SOLO-IT training could have also confounded study findings. Students
who felt they already possessed requisite computer and information literacy skills may have
reluctantly completed the training, and may have even resented the lack of an option to waive the
training requirement. Likewise, students who struggled with technology skills may have found
the online nature of the training insufficient for their learning needs, since it lacked immediate,
in-person feedback. Successfully completing SOLO-IT and receiving a completion certificate
may have given struggling students a sense of informatics competency, even when further
remediation may have been indicated.
Measurements of computer competency were based on self-perceptions which may not
accurately represent ability to demonstrate competency. Participants in this study may have
wanted to present themselves in a positive light, thus enhancing self-perceptions and biasing
study findings. Study subjects "have a tendency to want to present (themselves) in the best
light, and this may conflict with the truth” (Polit & Hungler, 1995, p. 312-13).
98
Completion of SOLO-IT provided many competency demonstration exercises and
knowledge acquisition assignments (quizzes). An average of two attempts per assignment was
necessary for most students to successfully pass each module and achieve the total minimum
completion score of 92%. Repeated attempts allowed students to review content and
practice/repeat demonstration exercises, but also resulted in high scores for every student
successfully completing the training (overall completion average was 97%). Such high
completion scores made the point spread within the data quite narrow and prevented an
opportunity to correlate students’ demonstrated abilities in SOLO-IT with their perceived
competencies, as rated on the SANICS.
The confounding variables of age and lack of nursing experience may have impacted
students’ understanding of some of the SANICS items. The majority of students (58.4%) fell
into the 20-29 year old age group. As first year students, it can be assumed these students had
little, if any, direct nursing experience. Competency on the SANICS assumed that students
possessed a certain degree of critical thinking skills. However, entry level nursing students may
not have understood some of the more complex items on the SANICS. For example, students
with no nursing experience may have lacked the background to fully comprehend and accurately
self-assess the competency item, “Recognize the value of clinician involvement in the design,
selection, implementation, and evaluation of applications/systems in health care”. Higher post-
scores could have simply reflected more familiarity with the item following informatics training,
rather than actual improved competency.
This study examined informatics competencies as reported by student perceptions via
pre/post surveys comprised of SANICS items. Actual demonstrations of informatics
competencies could provide comparative, objective data that would more accurately measure
99
competency, and facilitate remediation strategies specific to the learning need. Sufficient
research exists delineating the lack of informatics competency among nurses and nursing
students. However, the lack of published studies examining the role of nursing informatics
competency training precluded comparisons or lessons gleaned from similar training
interventions.
Finally, the possibility for a conflict of interest exists given the intervention for this study
(SOLO-IT) was also designed and implemented by the researcher. Full disclosure of this
association will be made in all forms of reporting and in the dissemination of research findings.
Implications for Future Research
This study was limited to a single population of undergraduate nursing students. Future
studies should correlate demonstrated and perceived competencies, and should include the
validation of competency instruments which measure informatics training interventions among
diverse populations of undergraduate and graduate programs and with nurses in clinical practice.
During the course of the study, the version of Blackboard was updated by the university,
requiring the SOLO-IT course be imported into the new version. During this process, the item
on the post-survey which prompted students to enter their numerical identification number was
inadvertently omitted, making it impossible to pair post- with pre-training responses. Future
studies should include numerically paired codes which could allow for paired comparisons of
scores for each participant, as well as correlations of actual skill demonstrations with perceived
competency scores.
While nursing informatics competencies have been described for more than a decade, a
comprehensive review of the literature revealed a surprising lack of research studies describing
training interventions to address the problem of insufficient informatics competencies among
100
nursing professionals. Published literature describing valid, reliable assessment tools to measure
the effect of informatics competency training among nurses or nursing students was also sparse.
Limitless opportunities exist for the creation, delivery, and evaluation of validated informatics
training products and instruments which can help ensure a highly qualified nursing profession,
capable of using and applying informatics in practice. Solution-driven research is recommended
to proactively address the need for a technologically competent nursing workforce.
Summary
This study explored the psychometric performance of the SANICS. Evidence was
presented which supports the SANICS as a psychometrically sound instrument when used in a
population of BSN entry-level nursing students. Archived pre/post SOLO-IT data were used to
confirm the factor structure and internal consistency reliability of the SANICS. This study
effectively demonstrated the responsiveness of the SANICS over time and supported its use as a
valid tool to measure pre- and post- informatics competencies associated with an online
informatics training intervention. Significant differences in each sub-scale mean score before
and after completion of SOLO-IT further supported the construct validity of the SANICS.
Results of this study suggest that SOLO-IT may be an effective tool for improving
perceptions of computer competencies among entry level BSN students. Future studies are
recommended which include paired samples of nurses and nursing students from various
populations which would allow for more extensive correlations. Finally, research is
recommended to correlate perceived informatics competencies with actual skill demonstrations.
Technology infused healthcare is rapidly evolving in an era of reform and expanding
regulatory demands. The concept of “competency” must be continually re-defined if metrics are
to remain current and reflective of a requisite informatics skillset for informed nursing practice.
101
As the nation’s largest consumers of health information technologies, it is no longer acceptable
for a coalition of 20 nursing informatics societies to endorse the European Computer Drivers’
License (ECDL) as the recommended solution for the lack of informatics competencies among
nurses. The ECDL was developed for use by a wide range of industries and does not address the
essential computer skills required in healthcare, or the unique challenges faced in the healthcare
setting (HIPAA, meaningful use, interoperability, etc.). Diffusion of informatics competency in
the face of ubiquitous change in healthcare will likely remain unrealized until the profession of
nursing responds with empirically grounded training innovations and validated instruments
which directly respond to the technological needs of today’s Registered Nurse.
102
Appendix A: Self-Assessment Nursing Informatics Competency Scale
Permission to use the SANICS granted by the authors
For each statement, indicate your current level of competency on the scale of 1 to 5, where:
1 = Not competent, 2 = Somewhat competent, 3 = Competent, 4 = Proficient, and 5 = Expert.
No
t
com
pet
ent
So
mew
ha
t
com
pet
ent
Co
mp
eten
t
Pro
fici
ent
Ex
per
t
1. As a clinician (nurse), participate in the selection process, design,
implementation and evaluation of systems
1 2 3 4 5
2. Market self, system, or application to others 1 2 3 4 5
3. Promote the integrity of and access to information to include but not
limited to confidentiality, legal, ethical, and security issues
1 2 3 4 5
4. Seek available resources to help formulate ethical decisions in computing 1 2 3 4 5
5. Act as advocate of leaders for incorporating innovations and informatics
concepts into their area of specialty
1 2 3 4 5
6. Use different options for connecting to the internet (phone line, mobile
phone, cable, wireless, satellite) to communicate with other systems (e.g.,
access data, upload, download)
1 2 3 4 5
7. Use the Internet to locate (e-learning, teleworking), download items of
interest
1 2 3 4 5
8. Use database management program to develop a simple database and/or
table
1 2 3 4 5
9. Use database applications to enter and retrieve information 1 2 3 4 5
10. Conduct on-line literature searches 1 2 3 4 5
11. Use presentation graphics (e.g., PowerPoint) to create slides, displays 1 2 3 4 5
12. Use multimedia presentations 1 2 3 4 5
13. Use word processing 1 2 3 4 5
14. Use networks to navigate systems (e.g., LAM, WLAN, WAN) 1 2 3 4 5
15. Use operating systems (e.g., copy, delete, change directories) 1 2 3 4 5
16. Use existing external storage devices (e.g., network drive, CD, DVD,
USB flash drive, memory card, online file storage)
1 2 3 4 5
17. Use computer technology safely 1 2 3 4 5
103
18. Navigate Windows (e.g., manipulate files using file manager, determine
active printer, access installed applications, create and delete directories)
1 2 3 4 5
19. Identify the basic components of the computer system (e.g., features of
a PC, workstation)
1 2 3 4 5
20. Perform basic trouble-shooting in applications 1 2 3 4 5
21. Use applications for diagnostic coding 1 2 3 4 5
22. Use applications to develop testing materials (e.g., e-learning) 1 2 3 4 5
23. Access shared data sets (e.g., Clinical Log Database, Minimum Data
Set)
1 2 3 4 5
24. Extract data from clinical data sets (e.g., Clinical Log Database,
Minimum Data Set)
1 2 3 4 5
25. Recognize that health computing will become more common 1 2 3 4 5
26. Recognize that the computer is only a tool to provide better nursing
care and that there are human functions that cannot be performed by
computer
1 2 3 4 5
27. Recognize that one does not have to be a computer programmer to
make effective use of the computer in nursing
1 2 3 4 5
28. Recognize the value of clinician involvement in the design, selection,
implementation, and evaluation of applications, systems in health care
1 2 3 4 5
29. Use wireless device (PDA or cellular telephone) to locate and download
resources for patient safety and quality care
1 2 3 4 5
30. Use wireless device (PDA or cellular telephone) to enter data 1 2 3 4 5
104
Appendix B: Course Overview and Grading Criteria
SOLO for a DELTA©: An Online Informatics Training Course Successful Online Learning and Orientation (SOLO)
for a DELTA (Digitally Enhanced Learning and Technological Arena)©
In order to prepare you for success in the nursing program, the nursing faculty at Xavier University
would like you to complete a nursing informatics training course called SOLO for a DELTA (SOLO). This
training course is embedded into an off-site distance learning platform called CourseSites© and is
operated by Blackboard©.
Why do I need SOLO for a DELTA?
SOLO (Successful Online Learning and Orientation) for a DELTA (Digitally Enhanced Learning and
Technological Arena) helps prepare nursing students for success by providing a self-guided, online
framework where new and experienced learners can work at their own pace to develop (or improve)
overall informatics competencies. One of SOLO’s key features is the ability for students to self-select
supplemental resources and tutorials to use as much or as often as needed. In SOLO, all students are
encouraged to repeat exercises, assignments, or quizzes with no limit on time or number of submissions.
Is SOLO for a DELTA required?
Yes. All new incoming graduate and undergraduate students will be required to complete SOLO for a
DELTA as a graded assignment in one of their courses: N 130 [BSN], N505 [MSN], N550 [MIDAS], N 496
[RN-MSN] and N556 [CNL]. SOLO for a DELTA is also a course pre-requisite for N 854: Advanced
Informatics [ALL MSN, including FNP].
SOLO is recommended early in the nursing program since the information contained in SOLO will help
prepare you with the foundational technological skills necessary for the nursing program and for nursing
practice.
Successful completion of SOLO is a pre/co-requisite for N 854 and is associated with assignment credit in
the courses listed above. Once you have completed SOLO, you will not have to repeat it during the
course where it is required (but you will still receive assignment credit/grade, if appropriate). Once SOLO
is completed, you will receive a Certificate of Completion with your final score. Be sure to keep this
certificate, and show it to your instructor as proof that you successfully completed the SOLO for a DELTA
Informatics Training Course.
How long will it take to complete SOLO?
The average time to complete SOLO is approximately 4 hours (with a range of 2-22 hours, depending
upon your experience and comfort level with computer applications).
105
Length of time varies widely, since students are encouraged to repeat exercises, assignments, and
quizzes as often as needed, in order to demonstrate competency. There is no limit in the amount of
time spent on a module, or the number of times an assignment or quiz can be re-submitted.
SOLO can also be accessed as often as needed in order to complete all six modules listed below. Since
each module builds upon information from previous modules, it is recommended the course be
completed within a one-two week period from the start date.
What informatics competencies are taught in SOLO for a DELTA?
SOLO consists of the following six modules:
Module I- Introduction to SOLO: Introduces nursing students to the features of SOLO and the Blackboard platform.
Module II- Navigating the Computer and Web: Introduces nursing students to the parts and functions of the computer and presents practice exercises for browsing the web.
Module III- Computer Applications: Presents computer applications commonly used by nurses, including spreadsheets, documents, and presentation software.
Module IV- Information Literacy: Presents library and web based research tools that support information literacy and Evidence Based Practice
Module V- Preparation for Research: Presents an overview of professional writing and publication principles.
Module VI-Issues for the Professional e-Nurse: Introduces future e-nurses to professional issues encountered in the clinical setting.
When do I start SOLO?
Once you have enrolled into the SOLO course, you will first be asked to participate in a survey as part of a research study. Completion of surveys is strictly voluntary, but will greatly assist us in evaluating the effectiveness of the SOLO course. As part of the study, you will do the following:
1) Prior to beginning SOLO, complete an anonymous 30 item survey. The survey will involve ranking your present informatics skills and competencies on a scale from 1 to 5.
2) After completing SOLO, repeat the same anonymous survey (with some additional items included for course evaluation purposes).
o Survey data are collected via a secure off-site server with SSL encryption. o Refusal to participate in the data collection procedures associated with SOLO cannot be
tracked, and there are no penalties for lack of participation or type of response. o Choosing to enter and complete the survey will indicate your permission to participate.
You will need to complete SOLO during the first two months of the semester as a required assignment in
one of the courses listed at the beginning of this document.
106
How do I enroll into the SOLO Course?
1) It’s easy! Check your Xavier email! We will e-mail your enrollment invitation. When you receive it, click on the link provided in the e-mail to be taken to CourseSites where you will register.
Select a user name that does not include your actual name or other identifiers (eg. Nurse1234), since pre and post course survey data will be paired anonymously by user names. Pairing of anonymous data will allow us to determine how much (if any), perceptions of informatics competency changed as a result of SOLO.
Data will be reviewed and reported in aggregate form only and cannot be traced to individual users.
2) Once you create your account, you will be automatically enrolled and can begin. 3) For your convenience, a SOLO Instructional Manual (Word document) is available at the
bottom of the first page of the SOLO course. 4) When you complete the course and all modules have been graded, a Completion Certificate
will be available in CourseSites. The certificate can be printed or saved. Your instructor may require you to submit this certificate as proof you that you successfully completed the course.
5) It is recommended that you add completion of SOLO for a DELTA Informatics Training Course to your resume!
An application requesting four continuing education (CE) units of credit has been submitted to the Ohio Board of Nursing. If/when that application is approved, CE credit will be awarded and a certificate provided to those who successful completed all six modules of SOLO for a DELTA.
What if I need help?
No problem! We are here to help! Simply contact the SOLO Help Desk at help@
. We will look into your issue and respond within 12 hours (excluding weekends and
holidays).
Wishing you every success on your SOLO journey and in your nursing education,
Judi A. Godsey, RN, MSN SOLO Course Designer; Assistant Professor and Informatics Coordinator Xavier University School of Nursing
107
SOLO for a DELTA©: An Online Informatics Training Course Successful Online Learning and Orientation (SOLO)
for a DELTA (Digitally Enhanced Learning and Technological Arena)©
Grading Criteria
SOLO for a DELTA
Objectives and Competency
Demonstrations/Activities
Needs to Repeat Module
and Assignme
nt
Needs to Repeat Module
and Assignme
nt
Needs to Review and/or Repeat Module
and Repeat
Assignment
Recommend
Review of Module. Repeat or
Correct and
Re-submit Assignme
nt
Achieved Maximum
Points Allowable
- No need to repeat Module
or Assignme
nt
POINTS
Module I Objectives: Introduction to SOLO: Introduces nursing students to the features of SOLO and the Blackboard platform. Objectives for this module include:
Describe the purpose of the Successful Online Learning Orientation (SOLO) course
Navigate the Blackboard platform
Perform a browser and software check in order to enable the necessary functions for course completion
Module II Objectives
Navigating the Computer and Web: Introduces nursing students to the parts and functions of the computer and presents practice exercises for browsing the web. Objectives for this module include:
Describe the parts and functions of a personal computer
Explore the use of the internet as a tool to inform nursing practice
Demonstrate the ability to use and manage an email account
Demonstrate understanding of the importance of anti-virus protection
Demonstrate the ability to back up computer files
For Modules I and II, you will demonstrate competencies by performing these activities:
1. Show What You Know: Computers Quiz
(5 points) 2. Show What You Know: Internet Quiz
0-1
0-1
2
2
3
3
4
4
5
5
108
SOLO for a DELTA
Objectives and Competency
Demonstrations/Activities
Needs to Repeat Module
and Assignme
nt
Needs to Repeat Module
and Assignme
nt
Needs to Review and/or Repeat Module
and Repeat
Assignment
Recommend
Review of Module. Repeat or
Correct and
Re-submit Assignme
nt
Achieved Maximum
Points Allowable
- No need to repeat Module
or Assignme
nt
POINTS
(5 points)
Module III Objectives Computer Applications: Presents computer applications commonly used by nurses, including spreadsheets, documents, and presentation software. Objectives for this module include:
Apply the document construction principles of Microsoft Word, Excel, and Power Point
Demonstrate the ability to save and edit documents
Demonstrate the ability to use and edit Excel spreadsheets
Create a PowerPoint slide presentation
For Module III, you will demonstrate competencies by performing these activities:
1. Show What You Know: Microsoft Word (5 pts)
2. Show What You Know: Excel (10 points)
3. Show What You Know: Power Point (10 points)
0-2
0-2
0-2
3-5
3-5
3-5
6-7
6-7
6-7
8-9
8-9
8-9
10
10
10
Module IV Objectives Information Literacy: Presents library and web based research tools that support information literacy and Evidence Based Practice. Objectives for this module include:
Describe the basic principles of nursing research
Demonstrate effective use of search engines
Locate scholarly articles and journals that support nursing research and Evidence Based
109
SOLO for a DELTA
Objectives and Competency
Demonstrations/Activities
Needs to Repeat Module
and Assignme
nt
Needs to Repeat Module
and Assignme
nt
Needs to Review and/or Repeat Module
and Repeat
Assignment
Recommend
Review of Module. Repeat or
Correct and
Re-submit Assignme
nt
Achieved Maximum
Points Allowable
- No need to repeat Module
or Assignme
nt
POINTS
Practice
Demonstrate the process for locating and evaluating scholarly websites
Discuss safeguards that should be applied when using social media
Module V Objectives
Preparation for Research: Presents an overview of professional writing and publication principles. Objectives for this module include:
Describe how to avoid plagiarism
Explain some of the common issues associated with copyright
Demonstrate the basic principles of scholarly writing using American Psychological Association (APA) format
Explore the role of Evidence Based Practice (EBP) in nursing
Describe the importance of nursing research posters as a means to disseminate research findings
For Modules IV and V, you will demonstrate competencies by performing these activities:
1. Show What You Know: Locate a Research Article; Complete an Assignment (30 points)
2. Show What You Know: Plagiarism Assignment (10 points)
3. Show What You Know: Research and APA Quiz (10 points)
0-9
0-2
0-2
10-19
3-5
3-5
20-25
6-7
6-7
26-29
8-9
8-9
30
10
10
Module VI Issues for the Professional e-Nurse: Introduces future e-nurses to professional issues encountered in the clinical setting. Objectives for this module include:
Explore the role of informatics in
110
SOLO for a DELTA
Objectives and Competency
Demonstrations/Activities
Needs to Repeat Module
and Assignme
nt
Needs to Repeat Module
and Assignme
nt
Needs to Review and/or Repeat Module
and Repeat
Assignment
Recommend
Review of Module. Repeat or
Correct and
Re-submit Assignme
nt
Achieved Maximum
Points Allowable
- No need to repeat Module
or Assignme
nt
POINTS
healthcare
Describe how Information Technology (IT) is transforming health care
Describe changes to healthcare due to the ARRA and ACA
Describe the roles and responsibilities of nursing in the area of health IT and PHI
Explain the difference between EHR and EMR
Outline opportunities for nursing in today’s technology rich healthcare environment
For Module VI, you will demonstrate competencies by performing these activities:
1. Show What You Know: ACA, ARRA, and ACO Quiz (5 points)
2. Show What You Know: EHR, EMR, PHR Quiz(5 points)
0-1
0-1
2
2
3
3
4
4
5
5
TOTAL POINTS
111
Appendix C: Power Analysis
112
Appendix D: University of Hawaii IRB Approval
113
Appendix E: Xavier University IRB Approval
114
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